Jim Morford is a Williamsburg resident and founder of the Health Care Payers Coalition of New Jersey, which he still serves as co-chairman. Before moving to Williamsburg, he was a founder and served as Managing Director of the New Jersey Health Care Quality Institute. He is currently a consultant to the Virginia Business Coalition on Health.

Your Health Matters by Jim Morford Published: August 2006 Health care in America is constantly evolving. However, more recent shifts mark a significant departure from the health care system we’ve known for the past fifty years. For more than half a century, Americans were led to believe that “Doctor knows best,” and that government was watching out for our best interests. Well, times have changed. Nearly 20 years ago managed care was proposed as a means of reducing health care costs by controlling the procedures insurance companies were willing to pay for. Instead, managed care placed much health care decision-making power in the hands of government bureaucrats and insurance company employees. Their objectives, I would maintain, are not necessarily in your best interest. Managed care was touted as a means to rein in ever-increasing health care costs, but not only did it fail to reduce costs, it significantly reduced the doctor’s role in a patient’s health care. Under managed care, those decisions are now subject to the review of insurance companies and government “gatekeepers” who decide if a doctor’s recommended care is acceptable for reimbursement. Today’s massive government health care bureaucracy is more focused on making rules and spending taxpayer dollars than on the quality of health care you receive. Most health insurance companies want to pay as little as possible in claims while collecting as much as possible in premium dollars. I’m not saying all insurance companies are motivated only by greed, but remember: Insurance companies are in business to make money. One solution suggested by some is turning the responsibility of health coverage over to the government by creating a national health care system that, ideally, would be free for everyone. But as author and columnist P. J. O’Rourke states in his book, All the Trouble in the World, “If you think health care is expensive now, just wait until you see how much it costs when it’s free.” Another alternative is consumer-directed health care, a system through which some employers now provide health care coverage for their employees at a (hopefully) lower cost. The system is based upon health savings accounts (HSAs) and health reimbursement accounts (HRAs), which are high-deductible insurance programs wherein the employer and employees pay much of the basic costs while insurance only covers more expensive procedures. Another proposed reform is a “pay for performance” system. Unlike in most business settings where results are rewarded, our current health care system is based on paying for procedures. Hospitals and private practices rely on income that is generally determined by the number of patients seen and the difficulty of procedures performed – without respect to quality of services. This system provides little (if any) incentive for health care providers to improve quality of care. By linking reimbursement to the quality of results, a pay for performance system could use incentives to drive better outcomes. With the information you’ll find in this column, you’ll learn new ways to exercise greater control over the many decisions that affect you and your family’s health. I am not a health care provider or a health care professional. However, as a layman who has spent considerable time advocating for improved health care quality, I hope to share my perspectives on a variety of issues and provide easy-to-understand solutions to the many challenges we face as both patients and consumers. I represent no special interest – only that of the public. Even in today’s changing health care system, you can control the kind and quality of care you receive, but it’s up to you. You have to take personal responsibility for your health. One way is to learn and understand the rights you have as a patient. Another is to know how to communicate effectively with your doctor. Still another is to know how and where to find important information about your health care options. Through discussions of these and other issues in future columns, I hope to help you become a smarter, savvier health care consumer.

Williamsburg Health Journal 4808 Courthouse Street, Suite 204 Williamsburg, VA 23188 757-645-4475 © 2007 RIAN ENTERPRISES, LLC