Saturday, March 14, 2009

Mandates don’t work against, but for, consumers

By Jeff Raymond
State view
Muskogee Phoenix

March 13, 2009 04:30 pm

— It’s practically an article of faith that mandates to cover specific conditions, drugs and treatments increase costs and lead to a greater number of uninsured.
What’s often overlooked is that mandates may, in the long run, save money.
Oklahoma has required insurers to cover the cost of diabetic testing and treatment since 1996. The cost of covering diabetic supplies pales in comparison to the cost of caring for diabetics who haven’t managed the condition.

Consider breast cancer: A mammogram costs $50 to $150. The average cost of breast cancer treatment is more than $20,000, according to the National Cancer Institute. Catching tumors early saves considerable money later, not to mention women’s lives.
In 2006, according to state Health Department data, 67.7 percent of Oklahoma women over age 40 reported having had a mammogram during the previous two years. In 1996, 59.5 percent reported having had a mammogram during previous two years. In 1988 the number was 42.9 percent.

Required coverage of mammograms has been on the books in Oklahoma since 1988.
The increase in mammography rates has come about because of many factors, including better education and increased availability. But we owe it to ourselves to consider the effect of requiring the procedure to be covered.

Oklahoma’s mandate count, 36, falls in the middle. Requirements range from hearing aids to well child care.

Interestingly, some states that have far more mandates have more affordable insurance and/or a lower rate of uninsured.

Opponents of mandates focus on their aggregate cost. Yet pinning down the cost of mandates is notoriously difficult. Estimates are unreliable, as the wildly varying estimates of the cost of autism coverage have shown.

We should begin looking at mandates as a reflection on the high cost and disappointing quality of health care rather than their cause. If health insurance companies would serve policyholders rather than block the care they seek, average Oklahomans wouldn’t seek redress through the legislative process.

Insurance companies’ routine refusal to cover common-sense medical care, especially cost-saving preventative care, has led to mandates. It’s time for Oklahomans to look at mandates as a way to improve health care for much less cost than ultimately caring for the sick.

The huge shift in political support for mental health parity illustrates this. Many researchers now accept that it’s cheaper to treat someone for mental illness than suffer lost work and productivity.

The National Association of Health Underwriters claims the more groups demand specialized mandates, the more “the train gets a full head of steam” and can’t be stopped. Disease- and condition-specific lobbies will queue up and demand coverage as well.

The organization slips into old scare tactics. With health care premiums for an Oklahoma family increasing by 62 percent from 2000-2007, requiring more in return isn’t asking too much.

Because coming up quickly with tens of thousands of dollars is impossible for most of us, the end result of requiring insurance companies to do less is to shift the cost to taxpayers.

Opponents of mandates argue that nothing is free. They’re right: Someone pays for health care. It’s just a question of whom — taxpayers or insurance companies.

Jeff Raymond is executive director of OKWatchdog in Oklahoma City.
Call it at (405) 824-2382.

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