3d Quarter 2012 Benefits Corner


         By Al Horan, Chair, CRA Benefits Committee

By the time you read this article I suspect that the U.S. Supreme Court will have ruled on the legality of Health Care Reform. No matter which way the Court rules, there are issues that still require attention. Following are observations that were recently expressed to me by an emergency room physician about our medical system.
There is a shortage of primary care physicians. Yet they are considered the model for delivering quality medical care at reasonable costs.

·         There is a need to better coordinate medical care. Currently, some medical tests are duplicated which results in unnecessary costs.

·         There is a need for tort reform. Currently, physicians generally have abbreviated office hours. Outside of office hours they are reluctant to give advice over the phone or ask the patient to see them the next day. Instead, patients are typically referred to emergency rooms.

·         There is a need to simplify administration. Because of delays in receiving approvals from insurance companies for CT scans, MRI’s or Ultra Sounds, sometimes patients will go to emergency rooms to receive these tests immediately without the need for prior approvals.

·         There is a need to assure payments from patients. In non-emergency cases involving non-Medicare patients hospitals generally require upfront payment of the patient’s share of the cost before treatment is provided.

At CRA’s Annual Meeting in May Dr. Allen M. Schwartz, Pharmacist and Senior Director of Clinical Product Consulting for Express Scripts (legacy Medco), addressed our Delegates about the current use of prescription drugs and what the future use may look like. Presently 53% of the U.S. population use prescription drugs to treat primary medical problems such as hypertension and diabetes. Also, for 88% of newly diagnosed diseases prescription drugs are the first line of defense. Yet, in many cases, the prescribed drugs do not work which results in new prescriptions for alternative drugs. Approximately $300 billion is wasted each year on ineffective drugs. This cost plus the continuing increase in drug costs caused by inflation are major problems that are contributing to the ever increasing cost of medical care.


What might the future hold for us? Dr. Schwartz feels that we will see a closer matching of drugs to the genetic makeup of the patient. Further, he feels that individuals will be monitored through the use of biometrics which takes into account their genetic makeups, their environments and their lifestyles. These changes should result in better treatment outcomes for patients while also reducing costs by eliminating ineffective and unnecessary drugs. In the case of the emergency room physician, they feel that we will probably see us move towards a universal form of medical coverage with cost controls, like Medicare, to address many of the weaknesses in our existing medical system. Coupled with the change in medical coverage we should also see the coordination of medical care, central recordkeeping, tort reform as well as the elimination of and streamlining of administration associated with medical care and medical insurance. They feel that if we do not take steps to change our current system we may see it collapse within the next ten years.


We don’t have to look far to see that our current system is failing. In the case of Medicare beneficiaries, there is an estimated deficiency of $294 billion for 2012. (Liabilities are estimated to be $502 billion and Medicare payroll taxes are estimated to be $208 billion. The Medicare deficiency represents approximately 31% of the total projected deficit of $934 billion for 2012.) In the case of other individuals we continue to see dramatic increases in the cost of their medical coverage. Their coverage continues to increase at a faster pace than inflation. With each increase there is a greater chance that they will drop their coverage. In our society we would absorb the cost of medical care for these individuals through various public programs like Medicaid.

Needless to say to say we are all concerned about what is going to happen to our medical system. However, rather than worry we can each play a part in controlling and reducing medical costs by adopting healthy lifestyles, by using medical care wisely and by following the medical advice given by our physicians, including taking our medications as prescribed.


I hope that this article will provide you with food for thought and perhaps in a small way provide information that will help you better understand what is happening in our great nation.