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. 

CALPIRG 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 $1,000 toothbrushes to giant price hikes 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 estimated 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.
  • 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 $179 million from premiums since 2011. By focusing on insurers’ payment strategies and quantitative goals and results, closer scrutiny of health insurers can complement 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: Ilmicrofono Oggiono via Flickr CC by 2.0, Images Money via Flickr CC by 2.0, skeeze via Pixabay CC0 Public Domain.

Issue updates

Blog Post | Health Care

Pulling Back the Curtain on Prescription Drug Prices | Emily Rusch

One of the big outstanding issues for the California state Legislature to tackle this year is the soaring cost of prescription drugs. CALPIRG is strongly backing SB 17 and other bills to increase transparency and accountability in the prescription drug industry. 

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News Release | U.S. PIRG | Public Health, Health Care

Our Statement on the Failure of the US Senate Health Care Bill

American consumers can breathe a sigh of relief today. The legislation that was narrowly defeated in the US Senate last night threatened to spark chaos in health insurance markets, raise costs, degrade quality of care, weaken protections for people with pre-existing conditions, and cause millions of Americans to lose health coverage.

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News Release | Health Care

Our Statement on Senate Health Care Bill

Statement by Jesse Ellis O’Brien, CALPIRG Health Care Advocate, on public release of the “Better Care Reconciliation Act.” 

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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 dropped 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 upheld 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 CALPIRG 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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Pages

News Release | U.S. PIRG | Public Health, Health Care

Our Statement on the Failure of the US Senate Health Care Bill

American consumers can breathe a sigh of relief today. The legislation that was narrowly defeated in the US Senate last night threatened to spark chaos in health insurance markets, raise costs, degrade quality of care, weaken protections for people with pre-existing conditions, and cause millions of Americans to lose health coverage.

> Keep Reading
News Release | Health Care

Our Statement on Senate Health Care Bill

Statement by Jesse Ellis O’Brien, CALPIRG Health Care Advocate, on public release of the “Better Care Reconciliation Act.” 

> Keep Reading
News Release | Health Care

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

This morning, health insurance giant Anthem dropped 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 upheld 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 CALPIRG 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.

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News Release | CALPIRG | Health Care

Bill to Set Limits on Rx Gifts to Doctors Has its First Vote

Today the Senate Health Committee will vote on CALPIRG-backed legislation by Senator Mike McGuire, SB 790, to rein in pharmaceutical company gifts to doctors. We believe this bill is an important complement to other efforts to increase transparency and accountability in the industry.  

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Result | Health Care

Consumer-Friendly Health Care

In the fall of 2015, the state Legislature passed a series of CALPIRG-backed bills designed to help promote a more consumer-friendly and affordable health care system in California. State Bill (SB) 137 will give consumers accurate, up-to-date information about their health plan’s network; Assembly Bill (AB) 339 will ensure people with chronic health conditions are not discriminated against by insurers; AB 1305 will limit deductibles and annual out-of-pocket maximums for individual members of families; and SB 546 will require health insurance companies to justify rate increases for large employers’ health insurance plans.

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Result | Health Care

New Health Care Marketplace Opens

We helped win real reforms that led to the creation of a new California health care marketplace, Covered California. New health insurance options are now available to small businesses and individuals that could save consumers a lot of money. Consumers are able to make choices based not only on cost, and access to care, but the quality of that care.

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Result | Health Care

Pro-consumer Health Care Reform

CALPIRG’s advocacy helped ensure the health care law will bring down costs by setting up a competitive health insurance marketplace. In 2010, California became the first state in the country to begin setting up our state health insurance exchange.

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Result | Health Care

Fighting To Make Health Care Affordable

Thanks to a new CALPIRG-backed law, insurance companies actually have to justify rate hikes to the public, bringing some much-needed accountability. Thanks in part to the new law — and public pressure, including 1,200 public comments from CALPIRG supporters — Anthem Blue Cross and Blue Shield of California both backed off of double-digit rate hikes.

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Report | CALPIRG | Health Care

California Health Insurance Rate Review: the First Five Years

In this brief, CALPIRG examines the implementation of rate review in California, and the results it has achieved for consumers and small employers across the state. Our analysis includes posted rate filings that were scheduled to go into effect between January 1, 2011 and January 1, 2016.

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Report | CALPIRG Education Fund | Health Care

Health Insurance Rate Watch: Comments on the Anthem Blue Cross Life and Health Insurance Company Proposal

Anthem Blue Cross Life and Health Insurance Company has proposed increasing rates on April 1, 2015 for nearly170,000 people who obtain their health insurance through 28 grandfathered plans offered by Anthem. CALPIRG Education Fund's Health Insurance Rate Watch project reviewed Anthem’s filing documents and found that Anthem failed to provide adequate justification for its proposed rate increase. 

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Report | CALPIRG Education Fund | Health Care

Health Insurance Rate Watch: Comments on Blue Shield Rate Filing

Blue Shield has proposed rate increases as high as 9.7 percent for policyholders in its “grandfathered” health insurance plans, those that were established before the Affordable Care Act was signed into law, affecting 40,070 Californians currently covered under the plans. CALPIRG Education Fund's Health Insurance Rate Watch project reviewed Blue Shield's rate filing and raised a number of questions and concerns to the California Department of Insurance. 

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Report | CALPIRG | Health Care

California Health Insurance Rate Review

In its first three years, health insurance rate review in California has saved consumers and small businesses $349 million.

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Report | CALPIRG Education Fund | Health Care

Comments on the Anthem Blue Cross Proposal to Raise Health Insurance Rates

Anthem Blue Cross has proposed rate increases as high as 24.9% for policyholders in their “grandfathered” health insurance plans that were established before the Affordable Care Act was signed into law. The rate changes average out to a 16 percent increase for 153,000 policyholders, impacting a total of 238,000 Californians currently covered under the plans. Our review found that Anthem failed to provide adequate justification for this rate increase.

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Pages

Blog Post | Health Care

Pulling Back the Curtain on Prescription Drug Prices | Emily Rusch

One of the big outstanding issues for the California state Legislature to tackle this year is the soaring cost of prescription drugs. CALPIRG is strongly backing SB 17 and other bills to increase transparency and accountability in the prescription drug industry. 

> Keep Reading
Blog Post | Health Care

Our Statement on the American Health Care Act | Jesse Ellis O'Brien

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.

> Keep Reading
Blog Post | Health Care

PIRG applauds decisions blocking health insurance mega-mergers | Jesse Ellis O'Brien

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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Blog Post | Health Care

A Setback for Consumers Worried about High Prescription Drug Costs | Emily Rusch

Yesterday a CALPIRG-backed bill that would have required the prescription drug companies to disclose some of the factors behind their skyrocketing prices failed to pass out of the Assembly Health Committee. The pharmaceutical companies had heavily lobbied against the bill. 

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Blog Post | Consumer Protection, Health Care

Pro-Consumer Healthcare Bills Pass Legislature, Await Governor's Signature | Jason Pfeifle

Late last week the California State Legislature passed a series of bills designed to help prevent unfair medical charges, excessive health insurance rates, and misleading information about access to health care providers. Together these bills, if signed into law by Governor Jerry Brown, will help promote a more consumer friendly and affordable health care system in California.

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