Experts from around North America converged on UNLV this week to discuss how to tame fast-rising health care costs.
Health care spending in the United States has doubled in constant dollars since the beginning of the century, while the population has only grown 15 percent. According to federal figures, health care costs average nearly $11,000 a year per person in the U.S.
The conference — Making the Affordable Care Act Affordable: How Can We Contain Healthcare Costs? — was presented at Boyd Law School by the UNLV Health Law Program and brought together healthcare, insurance and government officials.
Event organizer and Boyd School of Law Professor David Orentlicher said the Affordable Care Act has been a success in making health care more available but has lagged in its cost-containment goal, nationally and in Nevada.
“So what we’re trying to do is bring in experts to talk about what we know about why costs are going up and what we can do to bring them down,” Orentlicher said.
The problem, according to Orentlicher, is health care is not like other services people need. Care for some people is almost unlimited, while housing or food has limits.
Plus, it is difficult for people to say 'no' when it comes to health care.
“People want everything done often and they don’t like being told you can’t have this when it comes to health care services,” he said.
Orentlicher gave the example of Britain where health care officials won't approve a new drug if it is very expensive with a limited benefit. But in the United States, that is not the case. A drug with very limited benefit and a big price tag is still available.
Another difficult piece of the health care puzzle is ideas that look good on paper often don't pencil out in the real world.
For example, insurance companies wanted patients to have more skin in the game so they wouldn't run to the doctor for every little skinned knee or upset stomach.
Insurance companies started raising deductibles to get people to stay home instead of going to the doctor's office; however, it turns out people are not good at knowing when something like a stomach ache is just that or something more serious like appendicitis, Orentlicher said.
While the idea saved insurance companies money in doctor visits the outcomes were not great for many patients.
But perhaps one of the trickiest parts of health care is how money is made. Profit lies in treating a disease or illness - not preventing it.
Ortenlicher said a hospital in New York wanted to lower the rate of limb amputations of diabetes patients. They created a diabetes clinic to help people better monitor their blood sugar and control their disease.
It worked. The hospital performed fewer limb amputations, but that cost the hospital money and it had to close the diabetes clinic.
“We really need to be doing more in the way of preventing disease. It’s just very hard to make money on preventing disease,” he said.
While health care legislation on the national level seems mired in political fights, some have suggested the states will be the forging the new policy in health care.
“Nevada is one of the good states in terms of expanding access to health care, so we should be proud of that,” Orentlicher told State of Nevada. “People have access to the (insurance) exchange, we’ve done the Medicaid expansion.
“It’s good to see that legislators in Carson City have turned their attention to the cost problem,” said Orentlicher, who is both an attorney and medical doctor.
Despite the strides made by some states to improve access and address cost, Orentlicher said the U.S. really needs to look to how other countries have tackled the problem through the central government, not through a piecemeal approach by states and provinces.
“In the end, we’re not going to solve this in a state by state basis," he said, "We can learn from the states, but in the end, we’re going to need Congress and the president to in act something that works across the country”
Dr. David Orentlicher, professor, Boyd School of Law
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