Cost control

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Obama lists goals for health plan

President Barack Obama, providing the first real details on how he wants to reshape the nation's health care system, urged Congress on Wednesday toward an overhaul that would allow Americans to buy into a government insurance plan.

In a letter to two senators leading the health care debate, Obama also moved toward accepting a requirement for every American to buy health insurance, as long as the plan provides a "hardship waiver" to exempt poor people from having to pay.

Obama opposed such an individual mandate during his campaign, but Congress increasingly is moving to embrace the idea.

A bipartisan way to cut Medicare costs

Medicare is the federal health insurance plan that covers persons age 65 and over. The plan is primarily tax financed, but beneficiaries pay premiums, co-pays and deductibles. Some have private insurance that covers out-of-pocket costs. Medicare also insures persons who are permanently disabled and those with end-stage renal disease, regardless of age. Medicare pays private doctors and hospitals for the care of 45 million Americans.

The cost of Medicare has risen rapidly since 1965 as new technology has been developed, resulting in improved health for beneficiaries. The rate of cost growth in Medicare has been less than that for private health insurance, but projected costs are unsustainable and will contribute greatly to future deficits if nothing is done.

Medicare is expensive because of the people it covers: very ill disabled persons and the elderly. Medicare pays for the health care of 8 in 10 Americans who die each year. Costs are extremely high just before death, and our health-care system is set

The choices ahead for health care

On June 24, in a town hall meeting on health care at the White House, President Barack Obama stated that "we spend at least 50 percent more than any other advanced country and we don't have better outcomes in terms of infant mortality, longevity -- all those various measures of wellness."

The good news is we have a president who is so well-informed about the health care system. The bad news is the president is absolutely right.

The United States spends much more than other industrialized countries for health care, on a per capita basis or as a percentage of GDP, and we are not getting good value for our money. In addition to our dreadful rate of infant mortality, the U.S. ranks as worst out of 19 industrialized countries in regard to deaths that could have been prevented by proper care. Even well-insured patients do not consistently receive appropriate medical care. Although we excel at providing high technology services for acute conditions, we do not perform as well as other industrialized countries

Reform's worrisome direction

Some interest groups, commentators and politicians want to depict health care reform as a contest between health insurers and "everyone else." In fact, we are finding that many people - including many hospitals, doctors and experts with decades of experience in health care - are concerned that Congress is taking us in the wrong direction.

We don't apologize for speaking out on health care reform. We believe it is our responsibility - to our customers, to our employees and to North Carolinians - to speak frankly on this issue and to encourage everyone to let their elected representatives know where they stand.

We're not surprised that some activists would try to re-use our message to press for government-run health insurance. Their entire movement is based on a premise that most people don't stop to question whether health care would be affordable if only insurers could be coerced into charging lower insurance premiums.

Job-insurance link is strained

Bill Atkinson is CEO of WakeMed Health & Hospitals and is on an American Hospital Association task force on health-care reform. He recently began blogging on the hospital's Web site, www.wakemedvoices.org , about health care and reform. Here is a recent highlight.

Uwe Reinhardt's recent commentary on CNN.com highlights the economic dangers that threaten the American middle class if efforts to reform the health-care system fail. Reinhardt, a political economy professor at Princeton University, made some very interesting points about the relationship between health insurance and employment in our country.

Reinhardt warns that without health-care reform, "Millions [of middle class Americans] will lose their employment-based insurance ... and millions will find themselves inexorably priced out of health care as we know it." He also points out that companies view health insurance as part of an employee's compensation package -- therefore when costs increase, this financial burden falls on the individual