ELLSWORTH, Maine — You can forget about keeping government out of the health care business.
It’s already there, and it’s there to stay.
That was part of the message that Dr. Erik Steele brought Wednesday to the Eggs and Issues forum sponsored by the Ellsworth Area Chamber of Commerce. Steele is the chief medical officer for Eastern Maine Healthcare Systems and interim CEO at Blue Hill Memorial Hospital. He also writes a regular OpEd column for the Bangor Daily News.
“The federal government already insures between 60 [million] and 70 million people — federal employees, veterans, Medicare and Medicaid recipients,” Steele said. “The biggest insurance company in the country is the U.S. government — that is, you.”
The government may be the only entity that is “powerful enough to drive us all together.”
Health care is going to change, and as costs continue to escalate, people are going to demand that change, he said. Estimates are that by 2020, average Americans will spend half their income on health care.
“Do you think they’re going to let that happen?” he said. “We’re at a tipping point and people are going to become so frustrated at the costs that they’ll be willing to do anything to control them.”
Proponents of change point to other health care models around the world, and Steele said there already are vestiges of some of these systems in the U.S., pointing out the government-provided insurance through Medicare and Medicaid. In America, he said, most people who have insurance are insured through their employer, similar to the European model which is essentially an employer insurance system through which private companies provide insurance and private physicians provide the health care.
The U.S., he said, also has a Third World insurance model: 47 million Americans without health insurance.
Two key issues in the health care debate are getting everyone insured and getting the costs under control, Steele said.
“That’s going to drive the discussion,” he said.
In response to a question, Steele said Massachusetts had done the “absolutely right thing” by requiring that everyone in the state be insured, even though that state quickly discovered it was faced with tremendous costs involved in that system.
“They’re now looking at some radical things to rein in those costs,” he said.
He suggested that Massachusetts could provide a national model.
“We need to have universal coverage, and it’s going to cost us a bazillion dollars,” he said. “Then we can get into the issues of controlling costs.”
Steele offered some prescriptions for controlling individual costs. The top three were control weight, quit smoking and get active.
“The No. 1 determinant of health care spending is weight,” he said.
About 60 percent of Americans are overweight and about 30 percent are obese, he said. Weight contributes to a host of medical problems, starting with high blood pressure and diabetes.
For employers, he said, a 45-year-old man who smokes will cost a lot more in the next 10 years than one who doesn’t. Quitting smoking can have immediate health benefits and within a year can improve heart health substantially.
Supporting programs on weight loss, smoking cessation and exercise “can flatten the cost curve for you as an employer.”
Steele also suggested that individuals can cut costs by shopping for lower prices for medical procedures and by asking their physicians, “Do I really need that test, that pill or that procedure?”
By asking that question, he said, patients will start a discussion with their physicians that ultimately will be beneficial.
For those who want to get straightforward information about the various health care proposals, Steele suggested The Commonwealth Fund and Robert Wood Johnson Foundation Web sites, The New York Times online blog “Prescriptions: Making Sense of the Health Care Debate,” and the book “The Healing of America” by T.R. Reid.