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How do we keep health costs down?

August 24, 2018

When Ilse Hein slipped in a friend’s bathroom in Vienna, Austria, she was stuck in a hospital for around three months.

“They thought I would never be out of a wheelchair, and then they didn’t let me out until I could walk,” she said. “I was afraid of the bill.”

That bill, though, was low.

“I got in three months of therapy more than I could have gotten in 10 years in America,” she said.

Hein isn’t a socialist, she said.

But having lived in Austria, she could espouse a universal plan — one where citizens are taxed based on income to subsidize health care — from experience.

“If it needs to be done, it’s being done. And after all that, you don’t even get a bill — do you know how nice that is?” Hein said. “It’s an easy system. I don’t know why it isn’t done here.”

As a multiple myeloma patient who’s advocated for patients in Europe and America, Hein said she’s noticed a few differences in patients from area to area.

For one thing, the costs of care — admission, treatment, and any therapy needed after — are far less to the patient than in America, she said.

Patients also have way less stress across the pond, she said.

“We make it more complicated and more complicated, and that costs,” she said.

National systemic change was a popular topic of discussion at the Rochester Public Library’s meeting on rising health-care costs Tuesday, hosted by members of Senator Tina Smith’s staff.

According to a video played at the beginning of the meeting, rising health-care costs are the No. 1 issue Smith hears about from Minnesotans.

Tuesday’s meeting was the 10th stop in a six-week — so far — tour by Smith’s staffers to talk to constituents about their health care concerns.

Several of the people who spoke — many of whom worked in health care — felt penalized for living in Rochester.

Janice Draxler, the director of human resources at Family Service Rochester, brought up Rochester’s health insurance premiums, which are higher than those in the cities.

“We’re kind of penalized for having Mayo in our backyard,” she said. “That is frustrating for us, trying to keep premiums down for our employees.”

As those insurance deductibles and premiums rise, Sandra Banuelos, a MNsure navigator at Mayo Clinic, said more families may choose to forgo their insurance altogether and instead pay for services on a sliding scale.

Counterintuitively, it may be cheaper to simply pay that cost, which depends on income. “We try to help our patients as much as possible,” Banuelos said.

Paul Fleissner, Rochester’s Deputy County Administrator for health, housing and human services, said the conversation should be focused more on social determinants of health, like housing and access to transport.

“If we have pregnant girls who are homeless, they can’t go in for their prenatal checks,” he said. “They can’t make it to appointments.”

Sean Rice, with Zumbro Valley Health Care, also called attention to the problems that arise when nonprofits have to rely on grant funds and other non-permanent income streams.

The turnover for employees drives down client satisfaction, he said, which leads to patient turnover.

“If satisfaction goes down, people don’t come,” he said. “And if you’re churning, it’s hard to say, ‘In a year, here’s where we’d like you to be. Or in five years.’ … It’s a continual source of frustration.”

“Indefinite positions” are also tough to sell to would-be employees, he said, who are likely to move on shortly after they’re recruited and trained.

Usually the conversations with constituents touch more on high prescription drug prices, said Lindsay McLaughlin, outreach director for health care and aging for Smith’s staff.

Smith will introduce the Affordable Medications Act soon in Congress, she said, which would attempt to increase transparency around prescription drug prices and allow Medicare to use its buying power to negotiate for lower costs.

Courtney Lawson, of NAMI, said her experiences with the fee-for-service system left her out money for prescriptions that didn’t treat the root cause of her illnesses.

“It just incentivizes more and more services,” she said. “I didn’t have to be on prescription medicines — instead, I can supplement iron for six dollars.”

Many of the conditions the staffers have heard about at these meetings have been chronic conditions, McLaughlin said.

“I think the senator is learning that we can do a lot on the front end to avoid these high prescription drug prices and hospital admissions,” she said.