The heart of health care reform: Part I

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Customers sit in a waiting room, ready to be served. Photo via byu.edu

Editor’s note: This is the first post in a two-part take on the role of the consumer under Obamacare. The second post is here.

We've all been overwhelmed with news about health care reform this past year.

The onset of Obamacare and its many new rules — growing monopolies and mergers of health systems, massive insurance coverage changes — all have contributed in some way to a little more anxiety and worry by most.

While there are a few who are pleased with the options for coverage, most editorials across the nation speak to the growing frustration and lack of confidence in how we're “fixing” health care, and we continue to ask the question, “How is this saving anyone money?”   

Post-Obamacare industry

These changes are affecting everyone across the spectrum.

Employers who want to do the right thing for their hard-working employees are trapped between the rising health care coverage costs to manage illness and injury vs. spending corporate dollars proactively on meaningful, work-initiated wellness interventions. How to manage health insurance requirements is a part of every company's strategic plan.

Consumers are baffled and frustrated by rising co-pays and deductibles, complicated Explanation of Benefits and limitations in accessing what they need within “networks” and preferred provider programs.

The health care providers are equally hurt in many ways. In fact, the rigor of actually receiving payment for services rendered has never been more challenging. Costly emergency rooms are misused as primary care provider clinics — because of access issues, no family physician relationship or ongoing mental health issues, estimated to be 25% of all ER visits. If you ask any hospital administrator, you would be astounded by the bills that are never paid.

Consumer demand

So where does the responsibility for real health care reform really lie?

In the very capable hands of the consumer. It may take a catastrophic event to cause a true cultural shift, but we, the consumer, have to take responsibility for meaningful, long-term change in the health care system.

Consider this: If you're going to buy a house, the biggest investment of most of our lives, what do we do to prepare for this? We save our money for the down payment. We look extensively and research everything we need to know. We compare and contrast. Before we enter a mortgage relationship, we review the closing costs. We plan for our monthly payments. We have to prove that it's protected with insurance. And then, most importantly, after we move in, we take care of this most important asset.

What if we took the same approach to our own health? If we truly valued our health, we wouldn’t blink at a co-pay, because the service we're paying for has real meaning to our lives. If it didn’t meet our expectations as a “good”  service, we would voice our choice, and investigate options and be prepared to dialog about costs and discounts and expect and demand more from what we're buying.

Consumer choice

Great industries in our country were born from competition and exceeding customer expectations.

That’s what we need from health care. The customer’s needs should determine how and when services are delivered, and the more choices available the better. Quality evolves from demand, expectations and competition.

Educated consumers who take responsibility for their own health will ultimately change the face of health care. To a certain degree, our current system rewards consumers who make little investment in their own health or who are non-compliant with care recommendations, while there are few incentives for people who truly make healthy choices. This is slowly changing for the better.

From every perspective — the employer, health care provider, insurance company and consumer — the single most important piece is the behavior of the consumer. This has been the driving force of American economics and innovation throughout history.

I encourage you to commit to educating yourself and thinking about what it is that you need and expect from your health care provider — and then voice your choice. One person can make a difference.

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Holly Lookabaugh-Deur, PT, DSc, GCS is the founder and president of Generation Care and contributes 34 years of clinical experience to the company with rehabilitation clinics across West Michigan. She specializes in post-mastectomy management, cancer-related fatigue, geriatric fall-prevention programming and hockey-related injuries. Holly is board certified as a geriatrics clinical specialist, a certified LSVT physical therapist, specializing in movement principles for lifelong management of Parkinson’s disease, a certified wound-care specialist and serves as a fall-prevention researcher for the Centers for Disease Control. She is also part of the adjunct faculty at CMU’s physical therapy doctoral program, a regular columnist for Senior Perspectives and has provided more than 20 continuing-education courses for her peers. Holly studied as an undergraduate at the University of Connecticut, obtained a master’s in health science neurology from GVSU and a doctorate of science in geriatrics from Rocky Mountain University.