Health Care Costs and the Weather

Last week I attended an excellent forum on understanding and controlling health care costs in our state. As the presenters discussed the causes of health care costs from their various perspectives within the system, I couldn't help but think of a comment attributed widely, but not totally sourced to Mark Twain: "Everybody talks about the weather, but nobody does anything about it."

And so it often seems, health care costs like the weather are driven by forces beyond our control. Yet several at the meeting challenged this assumption. Many touted the big "Ts" - technology, transparency and treatment controls ("you can't always get what you want...") as possible solutions. But the real message was delivered in stark numbers by Emory University professor and researcher Ken Thorpe.

According to Thorpe, we are not victims of our own successes in doubling our life expectancy over the past hundred years with new and better medicines and diagnostics; rather we are victims of our own behaviors, what the experts call "modifiable popuation risk factors" such as obesity and smoking. Keneth Thorpe presented data that indicated that 30% - or one in three Americans - is now characterized as obese, up from 15% in the late 1970's. The cost of care attributed to diseases associated with this increase (diabetes, hypertension,etc) has risen from about 2% of total health care in 1987 to over 11 %. "Most of what is going on now to try to control health care spending is missing the target," Thorpe says. "Companies are tweaking co-pays and talking about health care savings accounts when really they need to redirect their focus to reduce the prevalence of obesity among children and workers."

To return to the cosmos metaphor... the fault "lies not in our stars, but in ourselves."

All the News That's Fit To Print

Last week the nation's paper of record the New York Times ran an interesting front page piece exploring the homecare marketplace and the pros and cons of using so-called "full service" agencies versus hired friend and neighbors - what the Times labeled "gray market" freelance workers.
New Options (and Risks) in Home Care for Elderly took what I believe were a few unfair shots at agency offerings, including suggesting (in the words of one expert) that agencies offer little distinction over self-hireds, except for the ability to conduct criminal background checks. (Not true: Agencies not only screen, but they train, closely supervise, support, provide back-up and benefits to their aides.)

Worth pondering is the fact that demand for home-based help - of either type - is bound to exceed demand as the baby boomer bubble moves to the "elder" stage. The NY Times reports that home health aide wages nationally average $9.34 an hour; but here in Massachusetts our own wage and salary survey data indicate that the average hourly wage now exceeds $12.00. Still not a lot - but at least we are trying, with the resources we have to improve wages, and working conditions.

This could easily turn into a rant about how society in general undervalues the services of certain sectors (homecare workers, teachers, social workers) while excessively rewarding others (athletes, entertainers); but that's been done; and its dull, boring and unalterable.

So.. the question is posed: what do consumers value in a home care transaction? Agency directed care vs. self hired? Have you tried either? Both? And where will needed new workers come from?

The New Yorks Times just scratched the surface of this issue.