Bush: More info, better health care

08/23/2006

Following Minnesota’s lead, he orders federal agencies to offer patients cost, quality data

BY JEREMY OLSON and RACHEL E. STASSEN-BERGER
Pioneer Press

Minnesota is ahead of the nation in publicly listing the costs of health care and ranking doctors and hospitals, which is why President Bush came here Tuesday to enact a federal plan to help people make more informed and cost-effective medical choices.

The president led a health policy forum in Minnetonka and signed an executive order requiring four federal agencies to provide cost and quality data. Bush also attended a $425,000 fundraiser for state Sen. Michele Bachmann’s congressional bid.

“Health care policy ought to be aimed at bolstering the consumer — empowering individuals to be responsible for health care decisions,” Bush told the largely receptive crowd of 400 health care professionals and local politicians invited to the event.

Democrats and privacy advocates criticized Bush’s health care initiatives, saying they did little to help the millions of uninsured get health care. But others said Bush’s order will expedite the “transparency” movement, giving people information that will help them make wise health care decisions.

“(The president) chose Minnesota because we’ve been ahead in putting some of these pieces together,” said Jim Chase, executive director of MN Community Measurement, which publicizes how often doctors provide accepted standards of patient care. State lawmakers have passed three transparency laws requiring that doctors, hospitals, insurers and pharmacists provide certain cost information to consumers.

Chase was one of five Minnesotans invited to talk with Bush and Health and Human Services Secretary Michael Leavitt at the forum. The panelists took no questions from the audience but some ribbing from a jovial president.

When Leavitt, in an example to show the need for universal electronic health care records, told of his mother having to fill out her name and address more than half a dozen times, Bush inserted, “My mother wouldn’t have (been) so patient as your mother. Hope she’s not watching.”

The president also solicited health care stories from Marilyn Carlson Nelson, CEO of Carlson Companies, and Dr. Laura Dean of Stillwater, who told Bush that her ob-gyn patients need cost information more than ever.

“I’ve been providing them with all kinds of medical information to make good decisions, but the financial piece has been missing,” she said, “and people need that to make good decisions.”

The president also praised Michael Howe, CEO of Minute Clinic, which posts price lists of the limited services it offers at retail outlets. Bush seemed surprised that anyone walking by a Minute Clinic could see exactly how much health care there would cost.

The president’s order, which he signed at the end of the Minnetonka forum, involved Medicare, the federal health program for the elderly and disabled, along with federal programs for the military, veterans and federal employees. Together, these programs represent one quarter of Americans covered by health insurance.

“If we have more consumer involvement in health care, then it makes sense, if that’s the goal, then it makes sense to make sure that consumers have got rational data from which to make choices,” Bush said. “And that’s not the case today in medicine, really, when you think about it.”

The order also calls for greater use of electronic medical recordkeeping.

Skyrocketing health costs over the past decade have ushered the transparency movement. In the managed care era of $10 copays, many people have had no incentive to understand the full costs of their medical care or prescription drugs.

Employers are passing more costs to workers, though, by creating higher deductibles and tighter coverage restrictions. Some employers have switched to “consumer-directed” plans, by which they give subsidies to workers but make them fully responsible for their health care costs.

Health policy officials have stressed that information on cost and quality is needed in order for consumers to make wise health care choices. Using the cheapest doctors, for example, might actually cost more if they have the worst outcomes and force patients to need additional medical care.

“Cost and quality equals value,” Leavitt said at the forum, “and if we have competition based on value, everybody wins.”

Private insurers have added online tools that compare cost and quality information and provide lists of recommended providers.

PreferredOne, a benefits administrator based in Golden Valley, provides some of the most detailed cost data for its members — publishing the actual prices it negotiates with providers.

“(People) are absolutely shocked when they see the difference in prices for common, ordinary procedures, said Marcus Merz, CEO of Preferred One. He was not at Tuesday’s forum.

The charges for CT scans and colonoscopies can vary by 400 percent in the Twin Cities, for example. Merz said people aren’t yet sure what to do with this information.

Still, Chase said that consumer interest in this information is vital. Doctors have adjusted prices and improved practices after seeing the data, but will be especially motivated if they know the public is basing medical decisions on the information.

“It must be exciting to be on the leading edge of substantial change,” Bush told Chase.

“It keeps us busy,” Chase replied.

“I know the feeling,” Bush replied to applause and laughter.

Proponents of universal health care argued in advance of Bush’s visit that more access to health care — not access to information — would best improve people’s health care.

State Democrats offered similar criticisms. Gov. Tim Pawlenty has unveiled several quality initiatives to control the costs of public health programs, but critics noted that his budget moves in 2005 removed 36,000 people from state-subsidized health benefits.

“They can talk about consumer-driven health care all they want, but unless they mean driving consumers off the health care rolls, they’re being disingenuous,” said Minnesota Democratic Farmer Labor Party Chairman Brian Melendez