We all pay the rising costs of care

The back pain that slowed high school dance-team member Shannon Mankins turned out to be a one-time spasm. But her visit to the doctor to get it checked drove up her insurance premiums in each of the next two years.

Now her mother, Kim Mankins, hesitates before she goes to the doctor and doesnīt report some visits to her insurance company for fear the company will raise her rates. She negotiates her own prices with hospitals.

Robert Mathie has tried to take control of his health care experience, too.

When persistent pain in the 63-year-oldīs shoulder pointed to advanced kidney cancer, he devoted his energy to learning everything he could about the disease. He discovered a drug trial in Seattle that could stall the disease and persuaded his local doctors to let him try it. The experimental drugs are free, but three trips to Seattle every month add up.

The cost of health care in Idaho is climbing at an unchecked pace, though you may not have felt the full impact unless you were left to find your own insurance, like Mankins, or got sick, like Mathie.

That doesnīt mean you arenīt paying .

THE BILLS KEEP GETTING BIGGER

In 1980, Idahoans spent just 6 percent of the stateīs total gross product on personal health care. Today, they spend more than 13 percent. Thatīs about average for the United States, and greater than Norway, Mexico, Canada and the other 30 countries tracked by the Organization for Economic Cooperation and Development.

Twenty-five years ago, it took less than 7 cents from every state tax dollar to pay for Medicaid, the state- and federally funded health program for the poor. Thatīs risen to more than 17 cents, and analysts project an unfettered Medicaid could consume almost 40 percent of the state budget by 2023.

Insurance premiums rise every year, and businesses and their employees have to figure out how to spread the costs -- and whether they can afford the increase at all.

At least 222,000 Idahoans donīt have health insurance, and that number keeps rising -- it has jumped 11.6 percent since 2000.

In all of the bad-news numbers about health care, experts say the growing number of uninsured people is the key statistic in the proof that the system is broken.

When more Idahoans drop or lose insurance, the costs go up for everyone else -- especially for the businesses that provide group insurance to most people who are covered. Small businesses decide they canīt handle the increase, so they drop their insurance coverage -- once again boosting the ranks of the uninsured.

"Weīre in a spiral thatīs not sustainable," said Sandra Bruce, the chief executive officer of Saint Alphonsus Regional Medical Center . "The health care system in this country is not sustainable."

And itīs only going to get worse.

Some 77 million baby boomers will begin to retire this decade, and studies show 60 percent of them eventually could need long-term care -- one of the most expensive pieces of the health care puzzle.

Idaho colleges are turning hundreds of qualified nursing students away while hospitals and other providers are warning about a coming shortage when boomer nurses finally retire.

But some local health care experts are optimistic Idaho can find its own ways to slow the cost increases and improve the quality of care. The Legislature is exploring ways to improve access to primary care, and the state is investigating ways to deal with the growing number of uninsured Idahoans.

Some say improvements can come only with sweeping national changes, but others see opportunities to fight the problem closer to home.

WHO SHOULD PAY?

The modern system evolved during World War II, when companies started offering health coverage to woo workers. Today, though, just 62 percent of Idaho workers have access to employer-sponsored plans.

The rest, like Mankins, a self-employed real estate agent, are left to fend for themselves in a system Idahoans with group insurance wouldnīt even recognize.

Their premiums are volatile, and the three major insurance companies that offer individual coverage in Idaho can use your history to gauge what you should pay next year. If you get sick, your rates can go up -- something folks on corporate group insurance donīt see.

"You think twice before going to the doctor," Mankins said. "If Iīve got something where I think it might be a problem, I usually call my doctor and ask her if I need to come in."

Mankins thinks about working for a company just for the benefits. On a group insurance plan, she wouldnīt have to worry about every doctor visit or the $1,200 bill sheīs about to pay so her 16-year-old daughter, Michelle, can get her wisdom teeth out.

But some experts and national leaders like President Bush say more people should act like Mankins, who has learned the true cost of a doctor visit and mammogram over the years -- not just her co-pay. They argue that only when people understand the true costs of their care -- and bear more of the costs themselves -- will they make the right decisions about their own care.

People ranging from West Valley Medical Center CEO Kathy Moore to former Republican House Speaker Newt Gingrich say such a consumer-driven system is the only way to cut costs.

Mathie, suffering from kidney cancer, is concerned about the costs -- he shopped around for insurance when he retired and moved to Eagle. But he hasnīt become an expert on his own disease to save his money. Heīs done it to try to save his life.

He has folders full of information he culled from books and the Internet on cancer and cancer treatment. He brings in reams of paper to his doctors, who debunk much of what he finds.

"I can understand why people have to sell their homes to pay for health care," he said. "Theyīre choosing between life and death. Thatīs what it comes down to."

That echoes part of the argument from those who support universal care: Should the best health care be available only to the people who can afford it?

The fight may come down to these two sides: a market-driven plan advocated by Gingrich or something closer to the universal coverage Hillary Clinton tried to create more than a decade ago. The battle to reshape the nationīs health care system will take place in Washington, D.C., but that doesnīt mean states and communities arenīt chipping away at the problem themselves.

"The tipping point is going to happen when enough people collectively focus on the issue," St. Lukeīs Health System CEO Ed Dahlberg said. "There are a lot of people trying to find solutions, but itīs going to take drastic change."

’ANYTHING IS ACHIEVABLE’

Around the country, people are trying.

Massachusetts lawmakers recently mandated that everyone have health coverage, and they set up a state program to help poor people pay for it.

San Francisco just became the first U.S. city to offer universal health care for all its residents, covering checkups, drugs and more for people without insurance.

The money to pay for it would come from taxpayers, businesses that donīt offer insurance and monthly premiums and co-pays based on a sliding scale of what people can afford.

Here at home, some experts think Idaho leaders and the health industry can make a difference.

In March, 16 local health care leaders met at the Idaho Statesman to discuss rising health care costs. The group -- which included hospital administrators, state lawmakers, insurance company executives, physicians and nurses -- and other officials the Statesman has interviewed this year agreed on a few key drivers for the rising costs:

Inappropriate use of the health care system, including emergency room visits for coughs or sore throats, and "defensive medicine," when doctors order expensive tests to keep from getting sued if they miss something.

New technology, which can save lives and improve health but costs millions of dollars that must be swallowed by insurance companies and other payers.

Hospital and insurance administrative procedures, which can take costly man-hours. These are often a result of federal or state regulations aimed at making people healthier.

The lifestyle choices many Americans make, which can drive up the costs of care for them and everyone else. Smoking and drinking are expensive habits, but obesity eclipses both.

Solutions, though, were a little more difficult to pinpoint.

"There is no silver bullet," Dahlberg said. "Weīre not going to solve this problem rifle-shooting issues. Weīre going to have to take a shotgun approach."

Bruce of Saint Alīs suggests a way to start: Cover every Idahoan with health insurance.

"Why donīt we try to fix it and be a learning laboratory for the rest of the United States?" she said. "Anything is achievable if thereīs a will to do it."

SIMPLE STEPS TO SAVE

Some hospitals, insurance companies, businesses and individuals have tried to decrease costs through simple changes.

Walter Knox Memorial Hospital in Emmett, for example, built a doctorīs office in its emergency room to treat the patients who were clogging the small emergency room in the evenings after work. The cost is comparable to visiting a family doctor .

Healthwise, a Boise company that has become one of the worldīs premier sources of health-related information, is testing a new form of insurance coverage on its workers: health savings accounts aimed at putting the employees in charge of their medical costs.

Some Idahoans have purchased low-premium, high-deductible coverage to pay for catastrophic costs, and saved the money they would have spent on premiums to cover incidental health costs themselves.

Others have joined religious groups that pool their money and pay their own costs, outside of the insurance system.

Former Gov. Dirk Kempthorne directed major changes to the stateīs Medicaid program, although federal laws are restricting some of the more innovative steps he hoped to take .

A state experiment to subsidize small-business health plans has seen some success, but steps to expand it are hindered, too, by the same governmental rules.

Idaho Health Care For All, a local group of physicians, nurses and others, wants the state to provide universal health coverage to all Idaho citizens.

"This would eliminate the uninsured, providing reimbursement for all the state residentsī medical needs, with services continuing to be delivered by the private sector," said the groupīs co-chairman, Dr. Michael Foutz, a family doctor in Kuna.

However it works, government has to find a way to take some of the financial pressure off businesses, Bruce said.

Longstanding federal laws make hospitals take care of everyone who comes to their doors, but the system fragments after that.

Most people have insurance to pay the costs. Others pay themselves. A growing percentage have federal Medicaid or Medicare, and the poorest of the poor get help from the county.

Those who fall through the cracks are written off by hospitals, which then charge everyone else more to make up for the loss.

"Itīs being paid for," Bruce said. "And now businesses say, īQuit shoving this on me. Iīm playing internationally and this isnīt how it works anywhere else.ī"

But sheīs upbeat about the possibilities, especially in Idaho, with just 1.4 million people and a Statehouse thatīs still accessible to local leaders.

In an interview in her office recently, Bruce consulted a few pages of notes filled with the statistics and numbers about rising costs at the hospital.

"What do we really want to do in Idaho?" she asked, flipping over the small stack of papers to their blank sides. "Why donīt we just pretend that the paperīs clean and start over?"

KIM MANKINS

Kim Mankins has a $5,000 deductible, which, she says, "I hope I never reach." She focuses on health -- training for the City of Trees Marathon with Boise RunWalk and exercise partners Roger McMurtry and Oliver (her dog). "If this is my mid-life crisis, this works for me," she jokes.

Kim Mankins knows the cost of health care better than most. She has insurance, but still pays almost all of her medical expenses out of pocket and doesnīt report some claims to her insurance company. That helps her keep the $310 she pays in monthly premiums for herself and her two teenage daughters relatively flat.

Mankins and her daughters, who live in Eagle, are part of the roughly 30 million people in the United States on individual health insurance plans.

"Youīre scared to file a claim," Mankins said. "Whatīs the point of having insurance? You almost wonder that sometimes."

ROBERT MATHIE

"We have enough savings for insurance for four years," says Robert Mathie -- thatīs if the premiums donīt continue to go up. "I can see why people lose their homes." Mathieīs dog, Ginger, recently had a tumor removed herself. Others are worse off than he is, he says. "(But) itīs been a hard year."

Robert Mathie used to hit the Greenbelt in Eagle every morning with his pointer, Ginger.

"I was running," he said. "My cholesterol was 110. I was in perfect health."

But a pain in his shoulder kept sending him back to the doctor. By the time a CT scan found the tumors, they had spread through much of his body.

Mathieīs a soft-spoken 63-year-old who falls in the gap between working and Medicare. He found a medical test for drugs that could hold the disease at bay for 10 months, give or take five.

He just passed his first five months.

TRACI GOFORTH

Traci Goforth gives herself a daily shot as routinely as brushing her teeth. The shot keeps her MS symptoms at bay. But because of MS, she said, "There isnīt an insurance company in the world that wants to insure you for any reasonable amount ... Iīm not disabled, Iīm not a senior, Iīm not a kid -- you fall between the cracks."

Traci Goforth had two young children and was just 32 years old when the doctors told her she had multiple sclerosis.

"I was freaking out," she said. "To me, MS meant you are disabled in a wheelchair for the rest of your life."

That was 14 years ago. Today, if you saw Goforth at Rembrandts Coffee Shop in Eagle or one of her other hangouts, you would never guess she has the disease. With the help of a daily shot and an active lifestyle, she can handle MS.

It was when she got divorced, though, and lost her husbandīs group insurance that the illness took control of her life. Now that daily shot costs her $700 a month. Doctors donīt want her to work full-time, but sheīs willing to if she can get the insurance she now needs.

KARA HOGE

As health care premiums have risen, Kara Hoge has had to keep switching insurance plans for her employees.

Even though the cost of providing health insurance is cutting into her profits at the small Boise contracting company she owns, Hoge wants to take care of workers like Shelly Brown , the office manager who needs health insurance for her husband and five children.

The state tried to help small businesses last year by creating a pilot program that subsidizes health insurance premiums. But the program is available only to companies that donīt offer health insurance.

"Why are we being penalized?" Hoge said.

Hogeīs story will be the first of five personal stories the Statesman will tell in this series. Watch for it Oct. 8.

Kara Hoge, right, worries about providing health care insurance to employees like office manager Shelly Brown, left .

To offer comments, contact Gregory Hahn at 377-6425 or Melissa McGrath at 377-6439 or e-mail healthcareidahostatesman.com.