If a pivotal piece of proposed legislation now being reviewed by a special task force is adopted, Utah would become the first state in the country to make getting health insurance similar to booking a flight online.
Whether Utahns actually want that much control over their own health, and whether the health-care system and insurance industry can change enough to allow it to work at all remain to be seen. In any case, task force members believe giving consumers Internet access to private and government health insurance Web sites and comparisons of plans they offer is critical to the success of a consumer/market-driven system they're designing.
"It will take a whole truckload of tools to make (the new system) work," Rep. David Clark, R-Santa Clara, task force co-chairman, said during a Thursday meeting. "We are trying to build in transparency and give the consumer base the power to make informed choices."
Reforming the system is an ambitious effort based on consumers being motivated enough to find out costs and how well an insurance plan would work for them. They could also pick their own individual insurance plan, and opt out of the coverage offered through the workplace, which is where most currently get their insurance coverage.
If the reform goes as envisioned, consumers would have enough data available to shop online for the best and least expensive doctor, surgeon, procedure or pill. They would be able to compare best outcome data from various centers and area hospitals before having elective surgery. And that decision would come after a careful consultation with their doctor or surgeon, who would be practicing in a new incentive structure based on the results and quality of services provided, not just financial rewards.
The technology that brought passengers the capacity to make every type of travel arrangement from a computer can do the same for health-care consumers and providers, task force members were told.
Some of the task force members fully endorsed the notion of putting health insurance literally in the laps of consumers. "Having a Travelocity for health-care insurance is a very exciting notion," said task force member Rep. Merlynn Newbold, R-South Jordan. Rep. Bradley Daw, R-Orem, a member of the Health Data Advisory Committee, believes providing a portal to information and outcomes data could be "a kind of Consumer Reports for health care."
Consumers now barely have a keyhole to look through, experts on health-care data management told the committee. To create an online portal, a lot is going to have to change, they said. Comparisons would have to be based on equal measures and survey standards valid, then the barriers to individuals buying insurance would have be removed.
The biggest barrier to individuals buying insurance is the marketplace, which is geared for businesses. Insurance carriers have said they are retooling for pools of individuals with the same needs rather than pools of employees from the same workplace. But some lawmakers and insurance-industry representatives say the effort to protect consumers can't exclude protecting insurance providers from too much risk.
The risk is mitigated if everyone is in the pool, not just the low-risk, young and healthy, which is by and large now the case. The chronically ill are often not given coverage by health maintenance organizations or they must pay exorbitant deductibles and premiums if they buy insurance themselves. A bigger problem for the task force is that some 280,000 to 360,000 Utahns have no insurance coverage.
Those risks, getting everyone covered by a plan, then empowering consumers and getting control on costs are all a matter of building initial transparency that is all but missing now, task force leaders believe, and that's why they made it the required first step of the reform.
Insurance providers told committee members they are concerned about the possible "gaming" by consumers who would sign up for insurance right before they need a procedure or they would require emergency surgery such as an appendectomy and decide to include a second procedure done such as a troublesome but tolerable knee injury repair.
Lawmakers said that under the new system, insurance companies would be given the ability to adjust to prevent tricking the system, but if the companies are allowed to exclude people outright, they will continue to do so, and if the system continues toward becoming exorbitantly expensive, it will be of no use. Economic experts have told lawmakers if something isn't done about changing the system, the price of insurance premiums will equal the average household income within 20 years.
That said, a health-care cost analyst told committee members, Utah is in better shape to do something that every state and nation is trying to get some control over.
"If Utah were a country, it would be right after Japan, which is ranked second worldwide for the quality and cost of health care," said Greg Poulsen, senior vice president of Intermountain Healthcare.
Poulsen, who is a national and international consultant on health-care costs, said that between 1950 and today, per-person spending on health care has increased from $800 to $6,000. The rapid breakthroughs in medical care have allowed people to live much longer, and people always want those best technologies and procedures that U.S. medicine provides, he said.
Whether people are getting the value that they pay for is the key question for everyone as the task force moves ahead, Poulsen said.
"When we receive care, we're usually spending other people's money and aren't the wise consumers we should be," he said. "Right now, the consumer and the provider aren't interested in cost savings."
Unlike other industries that have been able to provide services and products at lower prices because of technology, the health-care industry has actually done the opposite, Poulsen said."I have yet to talk to any group of physicians who don't agree we can use our resources to get better value," he said. "Ultimately, we might not decrease costs, but reduce how much more expensive it will be in five years. Just changing the slope of the cost line would be hugely beneficial."