Higher quality at a lower cost. That’s the vision for the future of health care, and that’s a big reason why Catholic Healthcare West, Hill Physicians and Blue Shield of California have teamed up again to form an accountable care organization (ACO), this time in San Francisco. (Last year, our three organizations built one of the first ACOs in the nation, which improved quality and reduced costs for Sacramento-area CalPERS members.)

There’s been a lot of talk about the promise of ACOs, but what do they mean for patients in real life? Perhaps the most noticeable difference is in the experience of entering and leaving a hospital. In this model, when someone is admitted to the hospital, an integrated process looks ahead. Follow-up appointments are scheduled even before the patient is discharged, and all clinical notes from the hospitalization are sent to the member’s primary-care doctor ahead of that follow-up visit.

As a result, patients have higher confidence in their care instructions, receive prompt follow-up medical care and are less likely to be readmitted for avoidable complications.

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President Obama announced this week his support for legislation that would give states more flexibility in meeting the objectives of his signature health-care reform. He said that this change would give states freedom to innovate and act as “laboratories of our democracy.”

This use of states as “laboratories” makes sense to anyone who has considered the massive challenge of reforming health care in America. Centralized control of an industry that affects all 309 million Americans, has revenues of over $2.3 trillion annually, and employs more than 14 million people is not possible. Given the tremendous diversity of our population, any one-size-fits-all approach is destined to fail.

In many areas, states can be more effective regulators than the federal government. Which transportation system works more efficiently — your state highway system or Amtrak? Would your state university get better results if it were run by the Department of Education? Who is more responsive — your local sheriff’s office or the TSA crew at the airport? Which has shown itself to be better at managing risk — life-insurance companies (which are regulated by the states) or Wall Street?

Furthermore, state officials serve smaller areas, live in the areas they serve, and are more accountable to their citizens than their counterparts in Washington, D.C. Constituents feel they have stronger connections and more influence with state and local officials than they do with their representatives in Congress.

In order to effect real change, the president should support the idea of states’ assuming the primary authority and responsibility for health care. In other words, he should support the Health Care Compact.

A growing number of states are uniting around the Health Care Compact, which would give states both the primary responsibility for health-care regulation and full control over federal taxes spent on health care within their borders.

The Health Care Compact is a governance reform, not a health-care-policy reform. It would change who decides health-care policy, not who or what is covered. The Health Care Compact is needed because no centrally planned, top-down reform can fix health care throughout the United States. Instead, each state should craft its health-care policies to fit its specific needs. Some states may choose a single-payer system, while others may opt for a health-savings-account system with subsidies for seniors and low-income residents. Under the Health Care Compact, each state decides which plan is best for its citizens.

Citizens and state legislators in more than eleven states are working to get the Health Care Compact passed by their legislatures, and the compact is being actively discussed in at least 25 other states.

The interstate compact is not a radical idea. Compacts are simply voluntary agreements between two or more states, and when consented to by Congress, they have the force of federal law. Compacts have been used throughout America’s history, even before we adopted the Constitution. Authority for compacts was established in the Constitution (Article I, Section 10), and more than 200 such agreements have been developed.

President Obama’s decision to ease the opt-out requirements is a small step in the right direction, but it falls far short of restoring citizen control over health care, and fiscal sanity to Washington. The Health Care Compact offers a choice to the president and Congress. They can continue their partisan bickering over federal health-care reform, or they can embrace an approach that is more likely to succeed, one that brings control closer to the people by putting states in charge of health-care dollars and policies.

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It makes sense when you think about it. If something is going to cost more, you might take steps to avoid paying for it if it’s not incredibly vital at the moment. According to a story in Mediapage Today entitled, “High-Deductible Health Insurance Results in Less Care,” that’s exactly what’s happening with many low-income families enrolled in high deductible plans. Regardless of income, one half of families enrolled in high deductible plans have avoided receiving a medical service due to its cost.

These plans are attractive due to their lower monthly premiums, and while proponents of these plans like the fact that they help people avoid getting costly medical procedures that might be unnecessary, the flip side of the coin is that many lower-income people aren’t simply avoiding medical procedures, they flat-out can’t afford them. In recent studies, it was shown that lower-income families were 300% more likely to skip even recommended medical procedures than higher-income families due to the costs of the procedure. The study also found that lower-income families in high deductible plans are less apt to talk to their doctor about a medical problem.

Will the Affordable Care Act help with this? It’s hoped so, by bringing more people into the health insurance pool in order to lessen the costs of insurance. While it’s questioned how much this will help skyrocketing medical costs, many see it as a step in the right direction.

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A lot of health insurance companies have been in the news due to their hikes in health insurance premiums. More and more often, many companies are pointing the blame elsewhere, including losing customers and even the recently passed Affordable Care Act. Well, according to an article from NPR entitled, “Health Law Hardly At Fault For Rising Premiums,” health insurance companies can’t really blame the recent law as a reason to raise premiums.

The article cites several examples from small business owners in which their health insurance brokers blamed health insurance reform for the rising costs of premiums. Jay Angoff, head of the Office of Consumer Information and Insurance Oversight for the U.S. Department of Health and Human Services, says “It would be inaccurate and silly to blame it on the new law. To the extent that the insurance companies blame the new law for rate increases, they know better,” Angoff says. He goes onto say that the new law would only raise rates between one and two percent.

Last month, HHS Secretary Kathleen Sebelius wrote a letter to the health insurance industry warning them about “falsely blaming premium increases for 2011 on the patient protections in the Affordable Care Act”. However, Robert Zirkelbach of the insurance industry trade group America’s Health Insurance Plans says that some part of the rate increases can be attributed to the new law, some portions of which just took effect. The article then goes onto list more likely culprits of the increases, like healthy people cutting coverage due to a weakened economy, among other things. Overall, however, opinions are still mixed as to how much savings we’ll see from the health reform laws.

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You might have negotiated a better price for a new car or bargained for a great lamp at your neighbor’s yard sale, but did you know you might be able to negotiate with your doctor to lower your out-of-pocket expenses?

According to a November 2007 survey by the Consumer Reports National Research Center, among those who have tried to negotiate medical bills, 93 percent were successful at least once.

“Everything in health care is negotiable,” says Andrew Cohen, spokesperson for The Access Project, a nonprofit organization concerned with improving health care access. “Negotiating can be a great way to reduce bills. Unfortunately, people often think that this isn’t an option when it comes to medical expenses, but it is something they can take advantage of.”

Larry Gelb, president and chief executive officer of Care Counsel, which provides employer-sponsored health care assistance, based in San Rafael, Calif., says there is no harm in asking if you can negotiate your medical bill if it becomes too much for you to handle.

“There’s nothing new about people asking for discounts on medical treatments,” says Gelb. “There’s a long history of patients negotiating with their providers for lower prices on elective procedures, such as laser vision surgery or psychotherapy.”

“In today’s economic environment, in which everyone is financially squeezed, providers will be more open to discounting their fees in order to maintain the volume necessary to cover their fixed costs. Also, the stigma attached to asking for financial aid has greatly diminished,” Gelb says.

There’s both an art and a science to haggling for lower health care prices, says Gelb.

“Research indicates outspoken individuals have better health outcomes,” he says. “But even I would think twice about creating bad feelings between me and my surgeon if I was about to have surgery.”

The doctor/patient relationship is as delicately balanced as the employer/employee relationship, Gelb says. “You don’t want to march up to your boss and demand a raise,” he says. “You’re probably much less likely to get the desired outcome by doing it that way than if you calmly explain the reasons why you need to make more money. The same thing goes for asking your doctor to lower his prices.”

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Hearsay and incorrect information often fuel people’s misunderstandings of health insurance. When was the last time you snuggled up with a cup of coffee and your health insurance policy?

According to the Life and Health Insurance Foundation for Education (LIFE) and the Henry J. Kaiser Family Foundation, the following myths are alive and well in the minds of most folks.

1. It’s cheapest to buy health insurance through an employer’s group plan

If your employer offers a group health plan, you’re likely experiencing annual hikes in premiums, reductions in what’s paid for by your employer, an increase in your out-of-pocket expenses and the possibility that you’re paying for lots of benefits you don’t want or need.

An individual health plan (the kind you buy on your own), especially for someone who’s healthy and young, can offer significant savings. Unlike individual plans, group health plans must abide by state health insurance mandates, which can require coverage for everything from autism to hearing aids to contraceptives to in vitro fertilization.

Although an individual health plan can deny your application based on your health status, Matt Tassey, spokesperson for LIFE, notes that if you’re eligible the plan can be customized to meet your specific health care needs.

“If you’re a man, you have no need to see an obstetrician. But if they have an employer-sponsored health plan, they are still paying for [the obstetrics coverage],” he says.

2. Health insurance is expensive because health insurance companies are driven by profit

Brenda Weigel, spokesperson for the National Association of Health Underwriters, says this is a common misconception. “The fact that health insurance is expensive is because health care is expensive. Or there’s the common misconception that Medicare administrative costs are lower than private plans, when in fact there is quite a bit of cost shifting,” says Weigel.

When patients use a government insurance program (such as Medicare), providers of health care shift more costs to people who have health insurance.

The result is higher premiums for people who purchase their insurance on the individual market and workers who receive insurance through their employers.

Rising prescription drug costs also fuel increases.

3. If you’re young and healthy you don’t need to pay for health insurance

Then what happens when you break your leg in a snowboarding accident or blow out your knee while playing soccer? If you find that your tonsils need to be removed, the cost of a tonsillectomy can start at $5,000, with another $1,500 per day for an overnight hospital stay.

“There is this idea that if they need to be hospitalized they can just go to the emergency room because they have to take you,” says Tassey. “We like to call them ‘young immortals.’ A problem arises when they have to be stabilized or, worse, have to stay in the hospital for an extended period of time. What happens if they have to be transferred somewhere else for care, or have to see a specialist? The cost could reach $100,000 once you add everything up and starting out their lives in serious medical debt can have a long-term repercussions on their financial future.”

Tassey says young people rarely think about health insurance coverage until it’s time to have a baby.

4. The highest numbers of uninsured people are under age 25

A 2009 report from the Kaiser Family Foundation, “The Uninsured: A Primer,” reveals that adults between 30 and 50 years old comprise the largest group of Americans without health insurance. The report stipulates that the reason for this trend is due to the recession. Many Americans have lost their jobs in recent years – along with their health insurance benefits.

The report states that about 19.6 million Americans between ages 30 and 54 are uninsured. The second largest group is 19 to 29 year olds, at 13.7 million. Children between 0 and 18 years follow at 8.2 million. Those aged 55 to 64 comprise the smallest group at 4.1 million.

The 2009 Commonwealth Fund Survey of Young Adults supports the above findings, as it revealed young U.S. adults between ages 19 and 29 to be one of the largest uninsured segments of the population. It estimates the size of this group at 13.2 million. Of the total young adults surveyed, about half lacked health insurance during the previous year. The recession may have also affected coverage for this group. Young adults are having difficulty finding jobs and when they do, the employers often don’t provide health insurance coverage.

5. COBRA is very expensive and a short-term health plan would be cheaper

The federal COBRA law allows you to continue buying your former employer’s group health plan if you are laid off. The catch is that the employer no longer has to contribute to the premiums. One alternative is buying a short-term health plan on your own.

If you are relatively healthy, a short-term plan could bridge the gap between other health insurance plans, but if you have a pre-existing condition, or need maternity care or prescription drug coverage, you may not be able to find a short-term plan.

Also, short-term plans generally require you pay high deductibles before coverage begins. This deductible can vary from $250 (for very healthy policyholders) to well into the thousands. When you consider the cost of meeting the deductible before the plan pays for medical care, COBRA may be the better choice, especially if you have a pre-existing condition. In addition, a typical short-term policy lasts a maximum of six months and the insurer is not obligated to renew your policy.

6. Large employers always offer health insurance to workers

While many large employers do offer health insurance benefits to their employees, all do not. According to the Kaiser Family Foundation, 98 percent of businesses with at least 200 workers offered health benefits to their employees in 2009, but only 59 percent of companies with fewer than 200 workers offered it.

But when workers are offered health insurance, they generally take it.

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A whopping 90% of leaders in health and health care policy believe the Affordable Care Act sets the right course for health reform. As the partisan war continues in Congress 68% of experts favor implementing the law with little or no change.

New reforms under the Affordable Care Act begin to bring to an end some of the worst abuses of the insurance industry. These reforms give Americans new rights and benefits, including helping more children get health coverage, ending lifetime and most annual limits on care, and giving patients access to recommended preventive services without cost-sharing.

These reforms apply to all new health plans, and to many existing health plans as they are renewed. Many other new benefits of the law have already taken effect, including rebate checks for seniors in the Medicare donut hole and tax credits for small businesses.

Nine percent of professionals believe the health reform law sets the wrong course for the nation, and none said that the health system as it stands now requires no major changes.

More than 80% think it is important or very important to implement state-based health insurance exchanges, the requirement that individuals purchase insurance coverage, and the expansion of Medicaid to cover more lower-income individuals.

In March 2010, Congress passed and the President signed into law the Affordable Care Act, which puts in place comprehensive health insurance reforms that will hold insurance companies more accountable, lower health care costs, guarantee more health care choices, and enhance the quality of health care for all Americans.

Whether a person gets health benefits through work, buys insurance, has a small business and desire to provide health coverage to employees, is on Medicare, or doesn’t currently have insurance, the Affordable Care Act gives ybetter control of your own decisions about your health coverage.

It makes insurance more affordable right away by providing small businesses with a tax credit to provide coverage, and in 2014, by providing tax credits to those who need help in buying insurance, representing the largest middle class tax cut for health care in history.

The Affordable Care Act is projected to reduce premium costs for millions of families and small business owners who are priced out of coverage today. This could help as many as 32 million Americans who have no health care today receive coverage.

Despite of incredible debate, once the Affordable Care Act is fully implemented, Americans will have access to affordable health coverage.

Health care leaders were asked about their views on new payment methods to curb costs and promote efficiency. Nine of 10 leaders believe that improving care coordination for patients with chronic conditions will be effective.

Other options that received substantial support include permanent increases in Medicare and Medicaid payments to primary care physicians, aligning payment methods and rates across public and private payers, and accelerating the implementation of bundled payment methods.

Few leaders believe allowing consumers to purchase insurance across state lines or expanding the use of health savings accounts will be effective in achieving a high performance health care system.

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The state House of Representatives passed a bill just before mid-break that would authorize a health care compact seen as an alternative to Obama care in that it would take health care out of the hands of the federal government and give it to the states.

House Bill 526, sponsored by Rep. Champ Edmunds, R-Missoula, now heads to the Senate for action after a 62-36 vote in the House.

An official with the Health Care Compact Alliance said the action is an important step.

“The Health Care Compact gives the health care decision-making power back to the people instead of the bureaucrats in Washington. It allows greater citizen influence, more competition, and more options for health care for millions of Americans,” Eric O’Keefe, chairman of the Health Care Compact Alliance, said in a media release. “This important legislation will provide the citizens of Montana with greater control over their government and, ultimately, over their health care.”

A spokesman for the Democratic Party in Montana referred a request for comment to Jackie Boyle, a policy adviser for the Montana Commissioner of Securities and Insurance.

Boyle said she doesn’t disagree with the concept of introducing more competition into the market, but said she thinks the national exchange outlined in the recently passed national health care legislation is the way to accomplish that.

“We’re really focusing all of our efforts on the health insurance exchange,” Boyle said. “That’s going to do exactly what (they) are trying to do on this interstate compact. It’s going to make it where consumers can shop for policies and compare policies.”

Edmunds could not be reached for immediate comment.

It does not need the signature of the president to take effect. The way health care works in a member state is not prescribed in the compact. Who and what is covered as well as the level of regulation are determined by each state after the compact is ratified.

The Health Care Compact is an initiative of the Health Care Compact Alliance, a nonpartisan organization dedicated to providing Americans more influence over decisions that govern their health care.

In January, political columnist Fred Barnes reported in “The Weekly Standard” that many states are using the Health Care Compact as an alternative to President Baraack Obama’s health-care package commonly known as “Obamacare.”

“By banding together, states would have far more political clout in Washington,” Barnes wrote. “Backers of the health care compact figure they need more than 20 states to pressure Washington to go along. Their assumption is members of Congress (even Democrats who support Obamacare) would be inclined to vote for a formal request from their home state. Members who oppose Obama-care would vote for it as well.”

Compacts, dating back to the Mayflower Compact of 1620, have been used to innovate reforms throughout U.S. history. Authority for compacts was established in the Constitution (Article 1, Section 10), and more than 200 such agreements have been developed. These are voluntary agreements between citizens, groups of citizens acting as states, and groups of states. When consented by congress, they have the force of federal law.

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“Courts can’t take more cuts.” “Health costs rising for city.” “Some part-timers have city benefits.”

Very frequently, it seems, I open The Gleaner to find articles about the rising cost of health care. The Kentucky courts resist further cuts in their budgets to shift the money to pay for increased Medicaid costs. The city must budget an additional half-million plus more dollars to pay for higher health care costs. A writer questions why part-time employees can receive health care insurance.

But in none of these articles do I see anything about getting to the root cause of the problem — the actual cost of health care. In the instances mentioned above, the issue really boils down to the fact that the actual cost of providing services (or at least what is being billed by health care providers) is rapidly rising, much more than the inflation rate.

The Kaiser Family Foundation, in a March 2009 report of a study by the Centers for Medicare and Medicaid Services (CMS), indicated that “the U.S. spent over $2.5 trillion on health care in 2009, or $8,160 per U.S. resident or 17.6 percent of GDP. In 1970, U.S. health care spending was about $75 billion, or $356 per resident, and accounted for 7.2 percent of GDP.

Health care spending has risen about 2.4 percentage points faster than GDP since 1970. CMS projects that by 2018, health care spending will be over $4.3 trillion, or $13,100 per resident, and account for 20.3 percent of GDP.” And this report does not include the additional increases recently seen subsequent to passage of the current health care bill.

At some point in time, there must be a shift in focus to a very aggressive attack on the actual cost of providing effective health care. There are many opportunities to attack actual cost drivers, among them tort reform, removal of state boundaries when shopping for insurance (increased competition), review of current treatment protocols, an online database of charges for services to allow the user to “shop” for their care, improving efficiency of health care provider services, streamlining the billing process, aggressive promotion of wellness programs.

Perhaps our local Methodist Hospital might begin the process by hosting a public forum to make the public more aware of what is being done, and might be done, locally to reduce health care costs. Perhaps our state government representatives might participate by explaining what is being or could be done at the state level to lower health care costs.

It would be a refreshing change to have a public discourse about issues which can actually impact health care in a positive way, instead of just arguing about how to pay for it.

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