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The new issue of the Chaparral contains an article [“GCC Trapped in
Health Care Crisis: How Cost Increases Affect All of Us,” November 2007]
on how healthcare costs can be contained by the patient while we
continue to wait for the national single payer health insurance that is
the only real solution to the national healthcare crisis. I agree both
of those points. However, it was disturbing to read the “boxed”
statement at the beginning of the article stating that although GCC
“employees” do not pay anything toward their district health insurance,
“employees” should still care about the issues raised. On behalf of at
least noncredit part-timers, I think it is necessary to point out that
we are indeed “employees” of the district and we do pay a 50%
contribution to our limited choice health insurance through payroll
deduction. As a group, I'm sure that most of us are pleased that our
union fought for those benefits and our employer agreed, but we see how
far we have to go whenthe word “employee” does not necessarily include
us.
Cheryl Johnson
Adjunct, Non-Credit ESL
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You are
right. We were referring only to fulltime employees and did not
acknowledge the difficult situation of our part-timers, who pay
out of pocket. Thanks for pointing this out. For more on this
subject, see
Adjunct
Junction on page 8 of this
issue.
—Ed. |
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While I agree with the article's [“GCC Trapped in Health Care Crisis,”
November 2007] emphasis on doing what we can to stay healthy and thus
keep insurance costs down, and I likewise agree with Cheryl [Johnson]
that there should have been a more accurate description of what benefits
are made available to various types of employees at the college,
I also think there is another perspective to add.
There are significant
“market failures” in the healthcare arena. It's difficult to compare
the quality of healthcare providers before you agree to use them and,
given the technical and probabilistic nature of treatment outcomes, it
is often hard to do so even after receiving care. The notion that we
can bargain shop for providers of emergency care is obviously
ridiculous. The fact that primary-care providers must usually be local
limits the ability of rural dwellers to act as empowered consumers. And
the list goes on…
This all leads to a health care system with inadequate accountability
from the market. Some of the “missing” accountability could be provided
by the government or by associations of medical professionals, but in
this country at least, not enough has been forthcoming. This lack of
accountability allows the healthcare system to get away with a number of
crimes that jack up our premiums unnecessarily. For example, the cost
of remediating medical errors is often very high (presuming the error
hasn't led to death, that is). Trying to weed out providers with high
error rates through our legal system is inefficient and costly for all
involved.
For another example, the Dartmouth Atlas Project (www.dartmouthatlas.org)
has tracked healthcare spending in various regions of the U.S. and
discovered that there is unwarranted variation in the practice of
medicine and the use of medical resources. In particular, care known
to be effective is significantly less common in some regions than in
others, care that should be driven by patient preferences is instead
driven by prevailing practice in the region, and regions with an
abundance of
capital-intensive medical resources overuse them in a bid to defray
costs (apparently).
The authors of the original
Chaparral article
divide factors that can lower health insurance premia into ones we can
control and ones we can't. Perhaps they would consider the insufficient
accountability for providers to be one of those factors we can't
control. But I believe we have some ability to affect it as well.
Of course we can lobby the government to crack down on the system, or
even take it over as Cheryl alludes to. But we can also try to remedy
some of the market failures. A group called the California Health Care
Coalition has been trying to do just that. They are working for, and in
some cases have already got, more data on health care outcomes from
providers (e.g., hospitals). Working with Blue Shield, they have
identified some providers in their network that are “high
performance”—that is, meeting higher quality standards than the minimum
to get into the network but at the same time doing so at a cost that is
at least 10% below average. They have also created a
model contract for
management of prescription drug benefits with high standards for
quality, data transparency, and cost.
So, in addition to doing what we can to improve our health as
individuals, we should also think of what we can do by banding together
as consumers as long as the current meshuggenah system continues as is.
Mike
Allen, Mathematics Division |