(08/02) Churchill once said “however beautiful the strategy, you should occasionally look at the results.” Consumers think Vermont has good hospitals, physicians and nurses but they are concerned about the cost of health care growing at double-digit rates. Their health insurance premiums are increasing due to the rising cost of health care.

Spending in health care is growing faster than the rest of the economy because people earn higher incomes and have greater expectations, more health services are demanded and it’s also used more frequently. As a result of increased health care spending, our life expectancy has increased.

Health care technology is state of the art. As it gets better and more sophisticated, it save more lives and we expect the best. However, it’s costly to purchase, maintain, and operate.

People in their mid life use twice as much health care as those half their age and almost four times as much by the time they reach sixty. So, as the population ages and the number of people those over 65 doubles in the next 20 years, health care cost will continue to increase.

Hospital spending has vastly increased as evidenced by our Fletcher Allen’s $200 million expansion. In Vermont, hospitals have a monopoly with no competitive forces to control costs and quality.

Spending on prescription drugs is the fastest growth area in health care. The shift to new, higher priced drugs and advertising drugs to consumers puts pressure on physicians to honor patient’s requests that may not always be cost effective. Also, our quality of life has improved because of new prescription drugs and consumers expect continued advances.

Our legislature also has an impact that affects health insurance. Laws require insurers to cover a wide array of services and items, not all of which people want. For example, through community rating, we require single males to carry maternity coverage and premiums are the same for all patients regardless of age or health condition. Mandates increase the cost of health insurance by at least 30% because of state policies.

State health insurance covers almost 25% of our population, the 2nd highest state coverage in the country. However, Vermont reimburses about fifty cents on the dollar for services and private insurers pick up the balance. Testimony has indicated this cost shift is increasing the cost of private insurance by about 23%.

There are things consumers can do to control health costs. The most basic is lifestyle and it does make a difference. Taking care of oneself impacts the amount of medical care a person needs. Exercise, a balanced diet, moderate use of alcohol, maintaining the right weight and not smoking all help.

Employers can encourage workers to shed pounds. Helping employees to pay for exercise equipment and weight loss programs can be cost effective. One in five adults are obese and that is one of the leading causes of heart disease, diabetes and other expensive medical conditions.

Everyone should make sure the information they give to medical providers and hospitals is correct and up-to-date. Once automated, this will improve medical decision making by retrieving and linking general medical knowledge and patient-specific data in order to identify all relevant medical options based on the patient’s unique characteristics. With this information, the patient could be a better source of cost control.

Patients should review bills and statements for accuracy and make inquiries if something doesn’t seem correct.

It’s also important that consumers are aware of public policy debates on health care, Medicaid expansion and insurance reform and how they affect their pocket books. The Vermont House considered insurance reform that would help lower costs but the Administration and Senate only supported changes to current policies that would exacerbate cost shifting and increase insurance premiums.

However, New Hampshire passed reform similar to what was considered by the Vermont House and steps are underway there to increase competition and provide consumer insurance choices. Anthem Blue Cross and Blue Shield is allowing members to buy individual insurance whose premiums will be based on age, health and health habits including tobacco use.

The NH reform, which passed in 2001, created a high-risk insurance pool for people with serious chronic health problems. The new law is intended to encourage younger, healthier people, many of whom are not insured, to buy insurance by lowering premiums. Twenty-eight states have high-risk pools.

We fear things in proportion to our ignorance of them. Action must be taken to address the health care dilemma in Vermont. However, consumers and employers must demand action rather than accepting escalating health costs and corresponding premium increases. We get what we accept!

Thank you for your calls and notes. I can be reached at 658-3975 (home), 228-2228 (State House) and via e-mail.

Rep. Frank Mazur
South Burlington