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Insurers and Employers: Bend Your Own Cost Curve

Rick Johnson, for HealthLeaders Media, July 28, 2009

The August recess for the U.S. Congress is fast approaching, possibly leaving behind the deadline President Obama set for health reform. The President has been playing the role of head cheerleader for reform for many weeks now, trying to get healthcare stakeholders and voters excited about a bill that he says could expand access, improve quality outcomes, and decrease costs.

But as a cheerleader, Obama isn't much of a quarterback.

He's left that job to Senator Max Baucus, D-MT, chairman of the Finance Committee. As the debates continue to swirl over how to achieve the three broad reform goals, Obama has supported many ideas: he says he wants a public plan, but he's open to insurance exchanges; he was against taxing health benefits, but said he'd consider a bill that includes such taxes; and he's open to mandating coverage, if there are affordable options and insurers won't discriminate against preexisting conditions.

In short, the President appears to be rooting for any plan that he can call reform, so long as it expands access. Still, Obama is having trouble rallying the Blue Dogs in his own party because the Congressional Budget Office says that, at best, the House's Tri-Committee bill is budget neutral.

Before the end of the week, Baucus and his group of six senior senators might reach an agreement-but it will likely result in a much more moderate bill that slashes liberal plans like public insurance and employer mandates.

Hearing and reading about the reform rhetoric on a daily basis, it's hard to believe that just a year ago medical travel was the hot healthcare story. Starting with the August recess, analysts say healthcare associations, insurance lobbyists, and other stakeholders will spend billions on healthcare reform advertising and lobbying efforts.

But whatever comes out on the other end of the reform debate, insurers and employers should not count on the eventually watered-down version of health reform-assuming some plan actually becomes law-to help change the direction of healthcare's cost curve.

No, it is wiser to exhaust the tangible options at hand. A truly progressive employer is striving today for a mix of employee wellness efforts and contracts with healthcare organizations-both home and abroad-that bring down the cost of some of the most pricy and common procedures.

At the same time, insurers should not get distracted by the daily reform rhetoric, and should actively seek out how they will respond to requests by employers to offer national and international medical travel as one way of limiting cost.

One day this health reform movement seems to gain momentum, and then the next day it loses traction. We've seen this play out the last time we had a first-term Democrat as President. Obama certainly is taking a different approach from Bill and Hillary, but we can expect that any bipartisan reform law will fall short of being truly universal and offer only modest, if any, cost controls.

So work today to bend your organization's cost curve. No one is going to do it for you tomorrow.


Rick Johnson is the Editorial Director for HealthLeaders Media. He may be reached at rjohnson@healthleadersmedia.com.

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