The health care market’s broken in the U.S., and it needs more help than Congress’s proposals are offering.

What cost $10,743 for per-employee health care costs at large employers in 2009 will cost will nearly triple to $28,530 in 2019 if the status quo continues. If legislative proposals currently being discussed in Congress are implemented, that cost grow to $25,435. With greater restructuring for value, malpractice reform, and evidence-based medicine, the per-employee cost rises less, to $23,151 in 10 years.

The menu of restructuring factors recommended by the Business Roundtable would soften per-employee cost growth to an annual rate of 4% — far lower than the double-digit increases U.S. employers have faced in the 2000s.
The key recommendations offered by the Business Roundtable are:

1. To transition to a value-based delivery/payment model

2. To differentiate and reward providers based on performance
3. To hold providers accountable for quality care
4. To provide individual consumers incentives and an infrastructure that supports them in making more healthy lifestyle and informed health care decisions.

The Business Roundtable’s report, Health Care Reform: Creating a Sustainable Health Care Marketplace, analyzes data from legislative proposals and finds they won’t help sustain the American health system over the next ten years.

Health Populi’s Hot Points:
As Ringo Starr has sung, “It don’t come easy,” and neither would the changes that the Business Roundtable recommends. But these are sound approaches to adopt which Congress hasn’t included in any bold strokes in the proposals now being debated on the Hill.
Per Ringo, it won’t be easy to get to a value-based payment model

Paul Ginsburg writes in the November 12 2009 issue of the New England Journal of Medicine, “If combined House-Senate reform legislation makes it to the President’s desk for signature, enactment would be only a start to the reform process….midcourse correction will need to be legislated to deal with unforeseen consequences.”

For example, what if employee health plan costs exceed the $25K per-employee forecast calculated by the Business Roundtable? This level could fall into a Cadillac-plan taxable event for the insured employee. If that’s the case, consumers who receive health plans from employers may find themselves in bigger pain than either employers or Congress anticipated. Forget the simple “Botax” for plastic surgeries; this could be a painful tax for people receiving employer-based health insurance.