CHAPEL HILL -- I couldn't agree more with the president -- the status quo is not acceptable. The American health-care system is complex and cumbersome. Few outside the industry understand how it works, or want to. So it's not surprising that many people are confused even about basic facts, like what drives costs, who pays the bills and why so many people lack insurance coverage.
North Carolina already has strong protections against the kinds of abuses President Barack Obama mentioned in his recent address to Congress, including prohibitions against dropping or watering down insurance coverage when someone becomes ill. When Gov. Bev Perdue and U.S. Sen. Key Hagan were in the state legislature, we were pleased to work with them and other legislators as they passed important patient safeguards in the N.C. Patients' Bill of Rights. But there is no mistaking that there is a lot of room for improvement. That's why we want to see a good health-care reform bill pass this year.
Just as someone who misdiagnoses a problem may pursue the wrong solutions, getting the basics wrong could easily make things worse. Much of the support for government-run health insurance stems from the mistaken belief that private-sector health insurers drive health-care costs. This sounds plausible to many people because insurance premiums impact them directly and they can see that premiums and cost-sharing have risen sharply. They generally don't see the pressure on insurers to keep costs down or how the supply of -- and demand for -- health-care services has exploded in recent years.
Health-care costs are driven by myriad factors, including an inefficient and fragmented health delivery system, unhealthy personal choices such as tobacco use and sedentary lifestyles, and a payment system that tends to reward quantity over quality. For consumers with private insurance, the problem is compounded by an estimated $88 billion in costs shifted to them annually because of inadequate government payments to doctors and hospitals for Medicare and Medicaid patients.
We all have a role to play in addressing these problems, including insurers. Health insurance reform and health-care reform are not the same thing.
Too much of the debate has been couched in combative terms that present a false choice -- either you're for a government-run health-care system or you're a defender of the status quo, with all its problems and inequities. Nothing could be further from the truth.
We're encouraged by Obama's apparent openness to a reasonable third path: build on what works in the system and fix its most pressing problems first. That means first requiring everyone to have health insurance, expanding Medicaid, creating business tax credits and providing subsidies to those who otherwise can't afford even basic coverage. Everyone will know that, regardless of health status or pre-existing conditions, they can get and keep coverage.
The president is right that this would be a tremendous accomplishment. And we're convinced that this can be attained without threatening the benefits of the more than 160 million Americans with private-sector coverage now.
It's time to move beyond scapegoating insurers -- no matter how politically safe polls say that tactic is -- and begin to tackle the really tough questions: How can we reward better health outcomes over more procedures? What kinds of incentives would convince us to take better care of ourselves? How can we more cost-effectively treat chronic conditions such as diabetes and high blood pressure that account for about 70 percent of our health-care dollars and that are often manageable and preventable through lifestyle change?
Blue Cross and Blue Shield of N.C. is committed to health-care reform and to playing a productive role in this important public debate.
Bob Greczyn is chief executive officer of Blue Cross and Blue Shield of N.C.
