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Make Health Care Work Better For America
IMPROVING QUALITY WHILE CONTAINING COSTS—Health care costs too much in this country, and doesn't deliver enough based on what we pay for it. Fortunately, many of the best ways to improve the quality of our health care would also help contain costs.
U.S. PIRG is calling on policymakers to go back to the drawing board and start working on solutions that will fix the fundamental problems in the American health care system.
The bitter and contentious partisan debate in Washington is focused almost entirely on how to contain or assign the extraordinary cost of health insurance. And the specific bills being debated would likely make things worse for millions of Americans by degrading the quality of care, weakening protections for people with pre-existing conditions, and forcing many Americans to give up the coverage they currently have.
But the biggest failure with these proposals is that they fail to address the underlying problem with the American health care system: We are spending far too much, and getting far too little in return, for our health care dollar. Despite a health care system world-renowned for developing advanced treatments, and an army of skilled and well-meaning doctors, nurses, researchers, hospital and pharmacy staff, our crazy-quilt health care system still fails to deliver an acceptable value proposition for consumers.
Health care is too expensive
Health care costs too much in this country, not because too many people have access to it, but because the system is simply too expensive. From $1,000 toothbrushes to giant price hikes for decades-old medicines like insulin, unjustifiably high costs are everywhere in the U.S. health care system.
And these excessive costs can largely be attributed to widespread waste that doesn’t actually improve quality of care — waste that is estimated to represent a third or more of every dollar we spend on health care. Fortunately, many of the best ways to improve the quality of our health care would also help contain costs.
How we can make health care work better
- Holding the health care industry to a higher standard. America’s health care system is world-renowned for developing advanced treatments. But we often fail to get the basics right, frequently failing to provide effective, low-cost treatments that work, triggering unnecessary treatments and higher costs down the line. By expanding research into evidence-based medicine and holding providers accountable to higher standards of care, we know we can make progress.
- Investing in prevention. Our current system rewards hospitals and doctors for performing as many procedures and prescribing as many drugs as possible, with little consideration given toward whether they actually keep us healthy and out of the hospital. We need to change those incentives, and provide easier access to preventative services. Despite some promising small-scale efforts, there’s still far too little being done to change this.
- Making health care safer for patients. Experts say that medical errors are the third most common cause of death in America, yet we do surprisingly little to prevent them. For example, a checklists have been shown to cut hospital-acquired infections in half, yet many hospitals have yet to implement this simple solution, or have failed to do so effectively.
- Holding health insurers accountable. There is often too little oversight to ensure insurance companies are delivering on their commitments to their members. In many states, insurers are not held to meaningful standards to ensure adequate access to needed services. Health insurance rate hikes receive little scrutiny even though states that review rates have cut a great deal of waste from premiums—for example, in Oregon, where OSPIRG’s advocacy for consumers has helped cut over $179 million from premiums since 2011. By focusing on insurers’ payment strategies and quantitative goals and results, closer scrutiny of health insurers can complement other efforts to drive systemic reforms to improve safety, increase care coordination, boost prevention, and bring down costs for consumers and small businesses.
- Comprehensive prescription drug reform. America’s prescription drug development and patent system is failing consumers, too often leading to egregious price hikes or the development and marketing of the next “blockbuster” drug that may be of marginal health benefit, rather than research into needed breakthrough therapies for life-threatening conditions. The savings from overhauling the patent system—which gives pharmaceutical corporations immense pricing power—can be reinvested in research into high-priority therapies. Other commonsense reforms could also make a huge difference, like allowing Medicare to negotiate drug prices, requiring drug manufacturers to explain the basis for their prices, and stopping anti-competitive practices by big pharmaceutical corporations.
- Price transparency for health care services. The very least we can do about rising health care costs is make sure consumers can get prices for services or treatment up front, to allow for more informed decisions about value, encourage price competition that could help keep costs in check, and create accountability for unreasonably high-cost providers.
- Preserving competition. With countless mergers in recent years between hospital systems, health insurers, pharmaceutical corporations and others, health care has become increasingly consolidated. Unfortunately, bigger is not always better for consumers; studies show consolidation often leads to higher prices and worse service. More scrutiny of health care mergers and tougher anti-trust enforcement against companies that seek to avoid competition could make a big difference.
- A public option health plan—e.g., providing Americans under 65 with the option of buying into Medicare or Medicaid—could provide consumers with a cheaper alternative to commercial health insurance, ensure that there are coverage options for consumers who lose their employer-based coverage or those in parts of the country where health insurers are dropping coverage, and put pressure on health insurers to provide a better deal or lose our business.
We need your help
Powerful health care industry lobbyists will fight these changes and work to preserve the status quo, and the politics of health care has never been more divisive. But now is the time—in fact, long past the time—for our leaders to work together to advance the public interest, and address the fundamental problems of cost and quality in our health care system.
Please join us in calling on Congress to take concrete action to make health care work better for American consumers by enacting these commonsense reforms.
U.S. PIRG Education Fund is co-sponsoring a free Zoom panel in which panelists will discuss two ways consumers and patients are harmed by drug industry price manipulation and lack of competitive restraints: step therapy and rebate walls.
U.S. PIRG Education Fund is co-sponsoring a free zoom webinar Wednesday, June 24, at noon ET on two ways consumers and patients are harmed by drug industry price manipulation and lack of competitive restraints. Consumers often don't get a fair price and don't always get an effective drug. Read further to register for the free "Rebate Walls and Step Therapy" event featuring leading experts.
Elizabeth Ridlington, Frontier Group Senior Policy Analyst explores some questions about how the coronavirus will affect health care spending overall and by governments, and the health care system itself.
The coronavirus pandemic is reminding us, once again, of how expensive the nation’s health care system is. It’s the high cost of health care that makes health insurance so expensive for individual consumers, employers and the nation, and the cost and structure of insurance can have real consequences for health.
Judge Richard J. Leon of the United States District Court for the District of Columbia today approved a massive merger of CVS, the country’s largest retail pharmacy chain, and Aetna, the third-largest health insurer in the United States, despite significant opposition from consumer advocates and health care organizations. Consumer Watchdog Adam Garber put out a statement in response.
Health Care | U.S. PIRG
In our politically divided time, it's difficult to see where we can find common ground. But the need to value the work of caring for our loved ones is one such place. PIRG Senior Director of New Economy Campaigns Evan Preston explains in his blog, "Toward Consensus on Caregiving."
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