Make Health Care Work Better For America

IMPROVING QUALITY WHILE CONTAINING COSTS—Health care costs too much in this country, and doesn't deliver enough based on what we pay for it. Fortunately, many of the best ways to improve the quality of our health care would also help contain costs. 

U.S. PIRG is calling on policymakers to go back to the drawing board and start working on solutions that will fix the fundamental problems in the American health care system. 

The bitter and contentious partisan debate in Washington is focused almost entirely on how to contain or assign the extraordinary cost of health insurance. And the specific bills being debated would likely make things worse for millions of Americans by degrading the quality of care, weakening protections for people with pre-existing conditions, and forcing many Americans to give up the coverage they currently have. 

But the biggest failure with these proposals is that they fail to address the underlying problem with the American health care system: We are spending far too much, and getting far too little in return, for our health care dollar. Despite a health care system world-renowned for developing advanced treatments, and an army of skilled and well-meaning doctors, nurses, researchers, hospital and pharmacy staff, our crazy-quilt health care system still fails to deliver an acceptable value proposition for consumers.

Health care is too expensive

Health care costs too much in this country, not because too many people have access to it, but because the system is simply too expensive. From to giant for decades-old medicines like insulin, unjustifiably high costs are everywhere in the U.S. health care system.

And these excessive costs can largely be attributed to widespread waste that doesn’t actually improve quality of care — waste that is to represent a third or more of every dollar we spend on health care. Fortunately, many of the best ways to improve the quality of our health care would also help contain costs.

How we can make health care work better

  • Holding the health care industry to a higher standard. America’s health care system is world-renowned for developing advanced treatments. But we often fail to get the basics right, frequently failing to provide effective, low-cost treatments that work, triggering unnecessary treatments and higher costs down the line. By expanding research into evidence-based medicine and holding providers accountable to higher standards of care, we know we can make progress.
  • Investing in prevention. Our current system rewards hospitals and doctors for performing as many procedures and prescribing as many drugs as possible, with little consideration given toward whether they actually keep us healthy and out of the hospital. We need to change those incentives, and provide easier access to preventative services. Despite some promising small-scale efforts, there’s still far too little being done to change this.
  • Making health care safer for patients. Experts say that medical errors are , yet we do surprisingly little to prevent them. For example, a have been shown to cut hospital-acquired infections in half, yet many hospitals have yet to implement this simple solution, or have .
  • Holding health insurers accountable. There is often too little oversight to ensure insurance companies are delivering on their commitments to their members. In many states, insurers are not held to meaningful standards to ensure adequate access to needed services. Health insurance rate hikes receive little scrutiny even though states that review rates have cut a great deal of waste from premiums—for example, in Oregon, where OSPIRG’s advocacy for consumers has helped cut over from premiums since 2011. By focusing on insurers’ payment strategies and quantitative goals and results, closer scrutiny of health insurers other efforts to drive systemic reforms to improve safety, increase care coordination, boost prevention, and bring down costs for consumers and small businesses.
  • Comprehensive prescription drug reform. America’s prescription drug development and patent system is failing consumers, too often leading to egregious price hikes or the development and marketing of the next “blockbuster” drug that may be of marginal health benefit, rather than research into needed breakthrough therapies for life-threatening conditions. The savings from overhauling the patent system—which gives pharmaceutical corporations immense pricing power—can be reinvested in research into high-priority therapies. Other commonsense reforms could also make a huge difference, like allowing Medicare to negotiate drug prices, requiring drug manufacturers to explain the basis for their prices, and stopping anti-competitive practices by big pharmaceutical corporations.
  • Price transparency for health care services. The very least we can do about rising health care costs is make sure consumers can get prices for services or treatment up front, to allow for more informed decisions about value, encourage price competition that could help keep costs in check, and create accountability for unreasonably high-cost providers.
  • Preserving competition. With countless mergers in recent years between hospital systems, health insurers, pharmaceutical corporations and others, health care has become increasingly consolidated. Unfortunately, bigger is not always better for consumers; studies show consolidation often leads to higher prices and worse service. More scrutiny of health care mergers and tougher anti-trust enforcement against companies that seek to avoid competition could make a big difference.
  • A public option health plan—e.g., providing Americans under 65 with the option of buying into Medicare or Medicaid—could provide consumers with a cheaper alternative to commercial health insurance, ensure that there are coverage options for consumers who lose their employer-based coverage or those in parts of the country where health insurers are dropping coverage, and put pressure on health insurers to provide a better deal or lose our business. 

We need your help

Powerful health care industry lobbyists will fight these changes and work to preserve the status quo, and the politics of health care has never been more divisive. But now is the time—in fact, long past the time—for our leaders to work together to advance the public interest, and address the fundamental problems of cost and quality in our health care system.

Please join us in calling on Congress to take concrete action to make health care work better for American consumers by enacting these commonsense reforms.

Photo credits, clockwise from top: , , .

Issue updates

News Release | Health Care

Our Statement on Senate Health Care Bill

Statement by Jesse Ellis O’Brien, U.S. PIRG Health Care Advocate, on public release of the “.” 

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News Release | Health Care

Great News for Consumers: Anthem Drops Bid to Take Over Cigna

This morning, health insurance giant Anthem  its troubled bid to take over one of its top competitors, Cigna. A February district court decision to block the proposed merger on anti-trust grounds was recently  by the DC Circuit Court of Appeals, but with Anthem’s decision today, this anti-competitive takeover bid is finally laid to rest. This development comes after months of work by U.S. PIRG and a broad coalition of consumer and health care groups, urging close scrutiny of the merger from state and federal regulators and raising questions and concerns about the potential impact on consumers.

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News Release | U.S. PIRG | Health Care

Our Statement on House Passage of the American Health Care Act

Today’s House vote is a big step in the wrong direction for American consumers and the American health care system. It’s no secret that there are plenty of problems with health care in America, but the AHCA in its current form not only won’t address the real problems in our health care system—it is likely to make them worse.

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News Post | Health Care

Our Statement on the American Health Care Act

Instead of taking on the high cost of health care and other urgent problems for consumers, Congress may be on the verge of severely damaging the nation’s health insurance markets, raising costs and degrading care for millions of Americans.

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News Post | Health Care

PIRG applauds decisions blocking health insurance mega-mergers

This week, in a big win for consumers, a district court took action to block the proposed merger between health insurance giants Anthem and Cigna. This decision follows a ruling last month that blocked the proposed merger of two more of the nation’s biggest for-profit health insurers, Aetna and Humana. These decisions come after months of work by U.S. PIRG and a broad coalition of consumer and health care groups, urging close scrutiny of the mergers from state and federal regulators and raising questions and concerns about the potential impact of the mergers.

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News Release | Health Care

Our Statement on Senate Health Care Bill

Statement by Jesse Ellis O’Brien, U.S. PIRG Health Care Advocate, on public release of the “.” 

> Keep Reading
News Release | Health Care

Great News for Consumers: Anthem Drops Bid to Take Over Cigna

This morning, health insurance giant Anthem  its troubled bid to take over one of its top competitors, Cigna. A February district court decision to block the proposed merger on anti-trust grounds was recently  by the DC Circuit Court of Appeals, but with Anthem’s decision today, this anti-competitive takeover bid is finally laid to rest. This development comes after months of work by U.S. PIRG and a broad coalition of consumer and health care groups, urging close scrutiny of the merger from state and federal regulators and raising questions and concerns about the potential impact on consumers.

> Keep Reading
News Release | U.S. PIRG | Health Care

Our Statement on House Passage of the American Health Care Act

Today’s House vote is a big step in the wrong direction for American consumers and the American health care system. It’s no secret that there are plenty of problems with health care in America, but the AHCA in its current form not only won’t address the real problems in our health care system—it is likely to make them worse.

> Keep Reading
News Release | U.S. PIRG | Health Care

Tips for Bypassing Healthcare.gov Glitches and Getting Enrolled

While experts work to fix the problems with the federal health insurance marketplace website, U.S. PIRG urges consumers to take advantage of other ways to enroll.

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Report | U.S. PIRG | Health Care

The Cost of Repeal for Young Adults

Before moving forward with the health care repeal, however, policy-makers must consider the real-life consequences that their policy choices would have on millions of young Americans. U.S. PIRG has examined official research, data, and projections from independent sources, to provide a detailed picture of repeal’s impact on young adults. The evidence reveals that young people would face significant costs if the Affordable Care Act is repealed.

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Report | U.S. PIRG | Health Care

The Cost of Repeal

The evidence suggests that the costs of health care repeal are substantial and many of the asserted benefits of repeal do not stand up under scrutiny. But policy makers have additional options. They instead should work to implement the law properly in the states and take the steps to lower health care costs which the federal law fails to take.

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Report | U.S. PIRG | Health Care

MAINE: The Cost of Repeal

The evidence suggests that the costs of health care repeal are substantial and many of the asserted benefits of repeal do not stand up under scrutiny. But Maine's policy makers have additional options. Maine instead should adapt the law's implementation to its needs and take the steps to lower health care costs which the federal law fails to take.

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Report | U.S. PIRG Education Fund | Health Care

Delivering on the Promise

The recently passed federal health care reform law will make significant changes in how health insurance and health care work for consumers, businesses, and local and state governments, as well as how insurers and providers operate. But whether Americans experience improved care, lower costs and greater access depends largely on what happens next. 

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Report | U.S. PIRG | Health Care

Uncovered

It's commonly assumed that young Americans are disengaged from the issue, that on the whole they are a healthy group who are unlikely to be affected by health problems or lack access to care. But the reality couldn't be more different. In fact, young people, including college students, are on the front lines of the health care crisis. They make up the largest age block of the uninsured, and face a uniquely challenging set of obstacles that often prevent them from getting coverage.

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News Post | Health Care

FTC consumer champion has industries making false health claims afraid, very afraid | Ed Mierzwinski

Adweek profiles FTC consumer chief David Vladeck and his campaign to make yogurt makers, athletic apparel makers, cereal makers and household name firms from Reebok and Skechers to Kellogg's and Dannon to either tell the truth about their health claims or pay. It's a nice piece on the FTC's work and on the longtime consumer champion, who heads back to his Georgetown Law professorship at the end of the year.

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News Post | Health Care

What's Next on Health Care Costs?

Now that the election is over, talk has turned to the need to work together and get results for America. It’s a tall order, and on the polarized issue of health care, it may seem like an impossible task. But here's why I'm optimistic that we can in fact make progress.

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News Post | Health Care

Here’s that Rx refill you didn’t order

Is your pharmacy refilling your prescription without your knowledge or approval, and billing your insurance company for the cost? If so, it’s the latest example of waste we shouldn't tolerate in our health care system.

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