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

News Release | CALPIRG | Health Care

More than 1 Million Californians Subject to “Unreasonable” Health Insurance Rate Hikes

“Health insurance rate review is an important tool for transparency and accountability, but it needs to be strengthened,” said CALPIRG Executive Director Emily Rusch. “It is unacceptable that so many consumers get stuck with health insurance rate hikes that are unreasonable and unjustified.”

> Keep Reading
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.

> Keep Reading
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. 

> Keep Reading
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.

> Keep Reading
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.

> Keep Reading

Pages

Media Hit | Health Care

Anthem to raise some premiums as much as 25%

Los Angeles Times: "We are very concerned Anthem proposed a rate hike this high without adequate justification," said Emily Rusch, CALPIRG's director.

> Keep Reading
News Release | CALPIRG Education Fund | Health Care

Top Tips for Getting Youth Enrolled in Covered California

CALPIRG Education Fund helps young people check out their coverage options through California's separate health insurance exchange.

> Keep Reading
News Release | CALPIRG Education Fund | Health Care

CALPIRG Education Fund Helps California Students Navigate New Health Insurance Landscape

With the main parts of the Affordable Care Act now going into effect, CALPIRG Education Fund has launched a statewide education campaign reaching out to students with facts about the changes, and tips to help them find the right coverage for themselves.

> Keep Reading
Media Hit | Health Care

Pay for Delay

Dr. Michael Wilkes from the University of California, Davis school of Medicine talks about pay-for-delay on his KCRW show "Second Opinion" 

> Keep Reading
Media Hit | Health Care

Consumers are paying more money for certain drugs

The California Public Interest Research Group  released the report on  a practice critics call "Pay for delay."   That's when brand name drug companies pay off generic manufacturers to delay putting generic versions on the market.  As a result, consumers end up paying a lot more. The study found in some cases hundreds of dollars more were spent on meds used to treat cancer,  depression and heart disease. 

> Keep Reading

Pages

Report | CALPIRG Education Fund | Health Care

At Stake: What’s on the Line for Health Care Consumers in the Pending Supreme Court Case

The outcome of the U.S. Supreme Court’s ruling on the Affordable Care Act (ACA) will have far reaching impacts on consumers. The law is already working to improve the quality of care and reduce costs, with millions of Americans experiencing concrete improvements in their coverage.

> Keep Reading
Report | CALPIRG Education Fund | Health Care

Making the Grade

Health care exchanges, authorized by 2010’s health reform law, offer the states the chance to address the twin problems of cost and quality, and help consumers get a fair shake when buying insurance. 

> Keep Reading
Report | CALPIRG Education Fund | Health Care

Building a Better Health Care Marketplace

The creation of a new health insurance exchange offers our state the chance to build a better marketplace for health care.  The exchange can help individuals and small businesses by increasing competition and improving choices in the state’s insurance market.  By providing better options and better information, and negotiating on behalf of its enrollees, the exchange can level the playing field for consumers.

> Keep Reading
Report | CALPIRG Education Fund | Health Care

Building a Better Health Care Marketplace Brief #7

The exchange is a store where consumers can buy health insurance products – and anyone who’s worked retail knows that however much work has gone into crafting strong policies and building an efficient back-office, if customers  can’t understand, compare and choose the products that are right for them, it just won’t work.  

> Keep Reading
Report | CALPIRG Education Fund | Health Care

Building a Better Health Care Marketplace: Policy Briefing #6

Medicaid will see its eligibility significantly increased in 2014, the same year the state exchange will open its doors. 

> Keep Reading

Pages

View AllRSS Feed

DEFEND THE CFPB

Tell your senators to oppose the “Financial CHOICE Act,” which would gut Wall Street reforms and destroy the Consumer Financial Protection Bureau as we know it.

Support Us

Your donation supports CALPIRG’s work to stand up for consumers on the issues that matter, especially when powerful interests are blocking progress.

Consumer Alerts

Join our network and stay up to date on our campaigns, get important consumer updates and take action on critical issues.
Optional Member Code