EDITORIAL: Health care crisis needs cure-stat

The IBJ

   There's little doubt our health care system is broken: Medical costs keep rising and an estimated 47 million Americans are uninsured. It's a problem that could bankrupt the country along with countless of its citizens caught up in the vortex of rising rates and falling benefits.

   Don't just take our word for it. Congressional Budget Office leaders said as much in a New England Journal of Medicine commentary late last year:
   "Our country's financial health will, in fact, be determined primarily by the growth rate of per-capita health care costs," CBO Director Peter Orszag and senior analyst Philip Ellis wrote. "Yet discussions ... have not seriously addressed the issue of how to slow growth in spending."
   Apparently, they haven't been talking to J. Patrick Rooney.
   As IBJ's J.K. Wall reports in his story on page 1 this week, the Indianapolis insurance-executive-turned-activist is looking to rein in soaring hospital costs and expand use of the health savings accounts he has championed for more than a decade.
   Yes, such reform would help his company, Medical Savings Insurance, and others. But we have to start somewhere.
   That universal health coverage everyone's been talking about? It's going to be unbelievably expensive without meaningful change in the ever-spiraling cost of care.
   HSAs and their companion high-deductible health plans are intended to address that to some extent by injecting free-market sensibilities into what has been a take-it-or-leave-it system. The theory: Making consumers responsible for paying for more of their medical costs should motivate them to shop around for the best prices.
   But the reality isn't quite there yet, in part because health care providers have been slow to get on the transparency bandwagon. Wall and two colleagues had just a 12-percent success rate last fall when they called to check local prices for common services. Among the challenges: the substantial discounts physicians and hospitals alike negotiate with various insurers.
   Rooney and his cohorts have challenged such discounts, not surprising since they put small insurers like him at a disadvantage. But the practice also means those who can afford it the least-the uninsured-are being charged the most.
   And that is unconscionable.
   Tax-exempt hospitals provide some charity care to the neediest of the needy, but what about the working poor or the underinsured? How many will be financially ruined trying to pay for life-saving surgery?
   It's a complicated issue, to be sure, but it's one we need to address-if not as a country then as a state, as Maryland has since 1976.
   There, a state commission reviews and sets hospital rates each year, a process that has resulted in hospital costs' dropping below the national average. When the state took over, rates were 26 percent above the average.
   That might not be the answer for us, but we need to find one. Stat.