MANCHESTER -- After sleeping quietly for a few years, the healthcare cost monster has awakened and begun feeding again.
It has left little for managed care companies, none of which mademoney in New Hampshire last year and most of which plan to raisepremiums by double-digits. In just the past few months, the monsterhas:
- Left Hitchcock Clinic facing an estimated $20 million loss.- Put Tufts Health Plan and Blue Cross/Blue Shield some $15million in the hole.- Led to the elimination by Matthew Thornton of managed care plansfor Medicare recipients and federal employees.- Convinced Hitchcock Clinic that it could no longer afford tosustain losses created by providing mental health services.- Created a furor in Concord over Capitol Region Family HealthCenter's decision to drop the costly practice of a popular doctor.- Has some hospitals once again facing losses and fighting forbetter deals from insurers who also lost money.- Caused more doctors, including nine at Hitchcock Clinic in Keenealone, to abandon clinics to escape the tightening rules of managedcare.- Prompted new attempts to control prescription drug costs bypromoting the use of generic medications.- Led to renewed calls for tougher laws regulating HMOs andpermitting patients to sue managed care companies for malpractice ifcare is delayed or denied.- Increased the number of Americans without health insurancedespite a prosperous economy.- And resulted in the election of legislators and a governor whomade health care reform a priority in their campaigns.'The costs are out of sight, they really are. But it's nothinganyone has any control over,' said Dr. Barry Stern, the Keenephysician who serves as president of the New Hampshire MedicalSociety.After several years of inflation in the low single digits, healthcare costs have headed upward again and are on a path to doublenationally from $1 trillion in 1996 to $2 trillion by 2007, accordingthe federal Health Care Financing Administration.'Our members are seeing increases ranging from 4 percent to 64percent,' said Katharine Eneguess, a Business and IndustryAssociation vice president.As premiums rise, some companies will absorb the cost, others willask workers to pay a share and some will be forced to decide thatthey can no longer afford to offer health coverage as a benefit.Most companies are negotiating health care coverage contracts withinsurers this month, Eneguess said.'This is not directly factual, but we are looking at an 80-20split for most employers who are offering benefits, except for a fewcontracts like those for state employees that still pay 100 percent,'Eneguess said. 'Most splits are at least 50-50, and some may be 60-40.'Some insurers, among them Blue Cross and Blue Shield of NewHampshire, are predicting premium increases in the 15 percent range.Since family health care coverage costs roughly $7,000 per year, anemployer who fails to pass along any of an increase of that magnitudewill essentially grant a $35,000 per year worker the equivalent of a3 percent raise.'Like everyone else, if something happens to me or my family, Iwant to be able to go to the very best for health care and I have theexpectation that because something comes out of my paycheck every twoweeks that I won't have to pay any more than that,' said LaurieStorey Manseau, director of public affairs for the DartmouthHitchcock Medical Center that oversees the Hitchcock Clinics. 'Now,the question has become, are you willing to pay the bill for whathealth care really costs?' Manseau said.When premiums rise it tends to be workers at the lowest incomelevels who are the first to lose health care coverage, Manseau said.When that happens they must then resort to using emergency rooms, anexpensive alternative that drives the cost of health care up evenfurther for everyone.Though there are still too many empty hospital beds and too manydoctors in some places, everyone agrees that the easy things tocontrol health care costs have been done. They also agree that thereare no bad guys to point to this time around.'Clearly we in this state and in the nation have benefited frommanaged care in terms of restraining costs,' said Terry Morton,commissioner of the Department of Health and Human Services. 'Now wehave to find something else that we need to do. Right now the UnitedStates spends as a percentage of its gross domestic product 13.5 to14 percent on health care, the highest percentage of any nation inthe world . . . yet at the same time we have not solved the universalhealth care crisis, and the other 10 industrialized countries doprovide that,' Morton said.In many ways, said Stephen Gorin, head of the New Hampshire HealthCare Coalition, the situation is not unlike the years before a newlyelected President Clinton unveiled his health care reform plan.'I hestiate to say where we need to go because I feel like I andothers have been saying it for years,' Gorin said. 'I think we needsome kind of universal coverage in this country. It is important forthe media to point out that this health care system just didn'thappen. This is the system that the people who defeated Clinton'shealth care plan in 1993-1994 said was the best system.'Politicians have yet to catch up with the public when it comes tohealth care, Gorin said. 'I do think that sooner rather than laterit will become the central issue again,' he said.Blue Cross spokesman Clark Dumont believes this year's round ofdouble-digit increases marks a one-time correction by insurers. 'Fora variety of reasons premiums have been below market, so 1999 will bea catch-up year, but we won't go back into the historicallyinflationary period that occurred before managed care became such apresence,' Dumont said.An aging population and rapid advances in technology, among themthe advent of genetically engineered drugs, will continue to pushhealth care costs ever higher. But the health care system is alsobecoming much better at determining what works and is thus worthpaying for and what doesn't, said Les MacLeod, president of HugginsHospital in Wolfeboro.Yet MacLeod, like Gorin, thinks it may again be time to reconvenethe national dialogue about whether the health care system shouldtake what it can from the managed care competition model and move on.'I think we make a mistake if we think there's one single answerout there and all we have to do is find it,' MacLeod said. 'My ownview is that health care is simply too important to leave to anunfettered marketplace. I was one of the people who took a single-payer system seriously the first time around, though I was clearlyin the minority,' Huggins said.'As our current system becomes just incredibly complicated andover administered, a single-payer system looks more and morepossible, although you will still have all the problems of a single-payer system,' MacLeod said. The next step is for the nation todecide how much is too much to spend on health care.'You can throw all kinds of money at health care and there willalways be an incremental benefit, but the question is, when is thatbenefit no longer worth the cause?' MacLeod said. The answer,unfortunately, tends to be 'when it's somebody else's kid in theemergency room, not yours,' he added.The system still wastes far too much money from patients who usehealth care needlessly and because doctors are forced to practicedefensive medicine to thwart lawsuits, said the medical society'sStern. But he holds out little hope for holding down costs in theface of ever-improving technology to improve health.A new genetically engineered drug that dramatically aids arthritisvictims hit the market last week. It works wonderfully and allowspeople who were virtually crippled to go back to work, Stern said.But each injection costs $110. 'The cost comes out to about $8,000per year. Is the insurance company willing to pay $8,000 per year soyou can function or is it going to say, `Stay home on disability,' 'Stern said. 'I can't make that decision. My job as a physician isto offer you the best treatment you can get -- but somebody has topay for it.'
