Statewide health self-insurance may be best for R.I.

Guest Column:
Paul Block
What do Rhode Island businesses want from their health care? According to four leading business groups, they don’t want to be responsible for the costs of providing access to care through Rhode Island’s health-insurance exchange for other Rhode Islanders. And why should they? More

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OP-ED / LETTERS TO THE EDITOR

Statewide health self-insurance may be best for R.I.

Guest Column:
Paul Block
Posted 2/10/14

What do Rhode Island businesses want from their health care? According to four leading business groups, they don’t want to be responsible for the costs of providing access to care through Rhode Island’s health-insurance exchange for other Rhode Islanders. And why should they?

As long as Rhode Island operates within a system in which each stakeholder’s interests conflict with the overall goal of the most affordable, effective health care for the state’s population, such positions are not only inevitable, they are appropriate. Unfortunately, they also sentence us to the unaffordable, unequal-quality care that we and the rest of the country currently suffer.

What do Providence Business News readers want from their health care? Certainly not what we have now.

Health care is unaffordable and getting worse. Forty-one percent of adults report problems with medical debt or difficulty paying for care. In Massachusetts, the 78 percent increase in health costs between 2001 and 2013 has crowded out spending on education, mental health, public health, environment and public safety, all of which have decreased in real dollars, a pattern replicated in Rhode Island and nationally.

Even with best-case projected savings from the Affordable Care Act, the average household share of total health care costs will be greater than total average household income by 2037. Rhode Island businesses can’t afford the health care system we have, and we can’t afford the rest of our state’s needs unless we fix it.

But businesses need healthy, productive employees, so the cost of health care has to be balanced against its value. Unfortunately, health care, in it’s current state, is a bad value.

According to the British Medical Journal, the effectiveness of half of the medical interventions that have been studied is still unclear. Rand Corp. researchers found that proven effective interventions are too rarely used in everyday medical practice because of the structure of financial incentives and clinicians’ difficulty translating research findings into manageable practices in the current system.

The result? According to the Commonwealth Fund’s Commission on a High Performance Health System, “the care that is provided is highly variable in quality and often delivered in a poorly coordinated fashion – driving up costs and putting patients at risk.”

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