September 05, 2015 News

Health Care is Like a Game of Whack-a-Mole®

During a recent staff meeting, I told my team that health care is like a game of Whack-a-Mole®. The second you knock down one problem, the next one pops up. From rising costs to increased regulation, the health care moles are popping up more and more these days. Unfortunately, the hammers that health plans once used to control them are getting weaker and weaker.

Mole #1

The biggest threat to the quality and cost of the care you receive is Big Pharma. I’ve said it before and I’ll say it again: Left alone, drug costs will bankrupt our system. The good news is that the American public is starting to wake up to the problem.

A recent survey by the Kaiser Family Foundation found that seven in 10 people support policy changes aimed at lowering drug prices. The survey goes on to say that 86 percent of people want a law on the books that would require pharmaceutical companies to detail where the money is going.

Sound familiar? The Affordable Care Act – among other state and federal regulations – requires health insurance companies to not only disclose where they spend money, it sets limitations on profits as well. If you’re a health plan CEO like me, you might be wondering, if we have to do it, why not them?

Six states, including New York, have introduced legislation in support of drug price transparency. If approved, the laws would require pharmaceutical companies to open their books and disclose exactly how much money is being spent on things like marketing, lobbying, research, and administrative expenses. While the public is largely supportive of this type of law, politicians have been overwhelmingly silent on the issue. That’s not surprising when you consider the fact that drug companies doled out $32 million in campaign contributions last year alone.

Mole #2

The effects of hospital consolidation on the quality and cost of care has been the subject of increased debate and research. While many hospital execs will argue that consolidation leads to improved efficiencies and lower costs, across the country we have been seeing just the opposite.

In fact, a recent study by Northwestern University’s Institute for Policy Research found that, on average, physician prices increase nearly 14 percent after a merger, with roughly 25 percent of that cost directly related to price exploitation. That is, larger health systems are demanding more money because they are the biggest – or only – game in town. The study goes on to find that there is NO evidence to suggest that integration leads to cost decreases, even four years after a merger.

Mole #3

Ironically, some of the biggest and most daunting challenges to the cost of health care have come in the wake of the not-so-Affordable Care Act. Not only did the law add a multitude of new taxes and fees ($14.3 billion by 2018) to the system, it also mandated that insurers cover a myriad of costly new benefits.

Here in New York, the ACA also meant the expansion of the Medicaid program and the creation of an entirely new government entity known as New York State of HealthTM.

While most of us can agree that Americans deserve access to better health care coverage, we must come to terms with the fact that these added benefits and expanded services cost A LOT of money. To make health care more affordable, elected officials must stop putting upward pressure on health insurers, who, by the way, want people to be healthy, which will ultimately lower costs. Instead, they should look at the true moles in health care and knock them down.


Photo by Jeffrey Kontur / CC BY

John D. Bennett, MD, FACC, FACP
About the Author

John D. Bennett, MD, FACC, FACP, is president and CEO of Capital District Physicians’ Health Plan, Inc. (CDPHP), an award-winning, physician aligned, not-for-profit health plan based in Albany, NY. Bennett has held the position since 2008 after serving more than 10 years as chair, vice chair, and board member for CDPHP. During his tenure, CDPHP has been ranked among the top-performing health plans in New York and the nation, most recently named #1 in Customer Satisfaction in the 2023 J.D. Power Member Health Plan Study. Under his leadership, CDPHP has also become known as a model employer regionally and nationally and was recently named among the top five Best Companies to Work for in New York by the Society for Human Resource Management, as well as Forbes Best-in-State Employers 2022. Prior to joining CDPHP, Bennett served as founding member and CEO of Prime Care Physicians, PLLC. During his tenure, he co-led a team of 25 cardiologists and helped grow the practice to a 100-physician multi-specialty group. Bennett is board certified by the National Board of Medical Examiners and the American Board of Internal Medicine, with subspecialties in internal medicine and cardiology. He earned his medical degree at SUNY-Downstate Medical Center, Brooklyn, and a Bachelor of Science degree at Rensselaer Polytechnic Institute. Bennett completed an internship and residency in internal medicine and a fellowship in cardiovascular disease at Albany Medical Center. He is a Fellow of the American College of Cardiology and the American College of Physicians. Bennett is currently board chair for the Center for Economic Growth and the Capital Region Chamber, and vice chair for the Palace Theatre. Bennett also serves on the boards of the New York eHealth Collaborative (NYeC), the Alliance of Community Health Plans (ACHP), America’s Health Insurance Plans (AHIP), Rensselaer Polytechnic Institute, and Russell Sage Colleges. Bennett is a member of the New York Public Health and Health Planning Council where he helps shape decisions related to New York State's public health and health care delivery system. Well-known locally and nationally for advancing health care innovation, Bennett was recently named to Crain’s New York Business 2021 Notable in Health Care, as well as the Albany Business Review’s Power 50 list.

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