Health Care Costs

More and more, open enrollment in company-sponsored benefits can be a confusing time, with a plethora of choices and additional responsibility falling on employees. Workers are given a stack of handouts each fall and are asked to choose among medical plans with varying coverage options, allocate pretax dollars to health and dependent-care savings accounts, and participate in wellness programs to save money. The burden of rising health care costs is shifting from employers to employees.

It is more than unfortunate that Anne Arundel County Executive John Leopold continues to imply that funding our school system is like throwing money into a bottomless abyss with absolutely no return on investment ("School funding mandate hurts counties," Jan. 19). There are certainly flaws with the state's maintenance of effort law, but the bigger problem in our county is Mr. Leopold's ongoing disparaging comments and his desire to control our school system in a dictatorial fashion.

The city's two largest unions set aside their collective differences with Mayor Martin O'Malley's administration and approved new contracts this week that provide pay raises to offset increases in health care costs. The City Union of Baltimore, whose members ratified the two-year deal Tuesday, signed the agreement yesterday. The American Federation of State, County and Municipal Employees Local 44 approved an identical agreement Sunday and signed it Tuesday. The Board of Estimates is scheduled to formally approve the agreements Wednesday, ending a contentious negotiating season for the city with its five unions.

Health care costs rose faster than inflation and wages this year — a trend that will hit home for many workers in the next several weeks as employers offer open enrollment. Employers usually pick up much of the tab for health insurance, but many are expected to shift more of this growing burden onto workers next year. That means employees are likely to see higher premiums and deductibles. And a growing number will be required to pay more up front, as more companies are adding so-called consumer-driven plans.

Contract negotiations with unions representing 1,700 Baltimore firefighters went to arbitration yesterday after the two sides failed to reach an early agreement. The firefighters' contract expires June 30. The early snag threatens to complicate scheduled contract talks with other city unions representing 16,000 municipal workers as Mayor Martin O'Malley embarks on crafting his first city budget. Baltimore faces a projected deficit of $153 million over the next three years. "The challenge that is created this year is that they [negotiations]

The military is proposing raising health care fees and deductibles for its 3.1 million retirees younger than 65 and their dependents, as well as co-pays for prescription drugs for all retirees this year, according to the proposed Department of Defense budget. Military associations have attacked the proposal - one of them sent more than 25,000 e-mails to members of Congress and inserted letters into its magazine that can easily be torn out and mailed to elected officials. The debate over the increases, which would nearly triple premiums for some retired officers between now and 2008, is likely to intensify as veterans accuse the Bush administration of disloyalty and broken promises, and as Defense Secretary Donald H. Rumsfeld and other top Pentagon leaders use charts and data on skyrocketing health care costs to make their case.

Irate state employees packed an auditorium last night, lining up to express outrage over increases in their prescription drug co-pays and other health care costs that took effect three weeks before the governor announced a billion-dollar budget surplus. Some in the audience of about 175 talked of cutting their pills in half to make them last longer. Others said they have given up their medicine altogether because of prohibitive cost. The increase in prescription co-pays took effect July 1 over the protests of state workers, but what renewed outrage over the issue, they said last night, was Gov. Robert L. Ehrlich Jr.'s announcement July 19 of a $1 billion-plus surplus in the state budget.

WASHINGTON - President Bush, laying out his domestic priorities in the days leading up to his State of the Union address, visited the National Institutes of Health in Bethesda yesterday to promote his plan to control health care costs. Telling an invitation-only audience that putting the federal government in charge of health care would be "bad medicine for the American people," Bush argued for private solutions instead. He pushed his proposals - including widening the use of inexpensive, high-deductible private insurance plans for individuals - with the help of a panel of like-minded citizens from around the country, put on stage by the White House to give testimonials to his program.

Last month, the National Coalition on Health Care released studies that examined the issues of cost, access and quality of health care.The problems identified in the three studies are:* Health care costs are increasing at twice the rate of inflation and consuming an increasing share of national spending.* Despite one of the greatest periods of economic growth in U.S. history, the number of uninsured people continues to increase, with more than 40 million Americans without health care coverage in 1995.

CLEVELAND - President Bush prodded doctors and hospitals yesterday to make better use of computers to share patient information, saying the health care industry's continued reliance on paper records inflates costs and undermines care. Participating in a talk show-style "conversation" with Cleveland-area medical personnel, Bush said the development of a nationwide data-sharing network was an integral part of his agenda for reducing health care costs. "Most industries in America have used information technology to make their businesses more cost-effective ... and the truth of the matter is, health care hasn't," Bush said.

The Sun editorial "Getting exercised over exercise" (March 28) makes some good points and then loses them in careless arguments that equate the need for healthy movement and activity with the war on obesity. There is no controversy about our need for more activity and the personal responsibility, along with civic choices, that are part of that. There is little question that doing away with recess and physical education are bad ideas with long term costs that far outweigh any initial savings.

Jay Hancock 's recent column ("Maryland business a no-show in fight over the cost of health care," Feb. 22) did not fully describe the efforts of the Maryland Chamber of Commerce and employers in our state to slow the rise of health insurance costs. We have, in fact, already taken positions on 16 health care bills before the Maryland General Assembly and are reviewing more. Our positions are based on our 800 members' needs and interests and determined through rigorous committee processes.

Both the column by Jay Hancock ("Orthopedist-owned MRIs are recipe for soaring medical costs," Feb. 8) on orthopedist-owned MRI machines and CT scanners and the response by Dr. James York raised issues that need to be considered. However, both failed to address an important point: The overall impact of the proliferation of the devices on the cost of health care in this country. Other than in hospitals, MRI machines and CT scanners sit idle for many hours of the day. In the aggregate, the supply of MRI machines and CT scanners in the Baltimore metropolitan area greatly exceeds the reasonable demand for their use. Excess capacity is anathema to the success of most enterprises.

Congratulations to Doug Mainwaring for having saved $100,000 in health care costs by opting to "self insure" and for being in a position to spend that amount in the future ( "Health reform unfair to self-insured businessman," Jan. 18). I am sure that will be a great comfort to the millions of working stiffs in this country who earn half that much or less each year. More to the point, Mr. Mainwaring's argument suffers from the classic economic fallacy, "past performance predicts future performance.

It's a triumph of hope over experience, perhaps, but as much as Maryland physicians complain about insurance company cost-cutting, there seems to be genuine optimism among doctors over CareFirst BlueCross BlueShield's latest effort to reduce the cost of health care in this state. That alone bodes well for what amounts to a voluntary program that will rely on support from primary care doctors for it to have any chance to work. Approved this week by the Maryland Health Care Commission, CareFirst's Primary Care Medical Home or PCMH is designed to move away from the nearly universal fee-for-service model that offers financial incentives to the medical community for treatment of illnesses but not for any improvement in the health of patients.

Like schoolkids who had pulled the fire alarm to get outside on a nice day, the City Council members gathered in front of City Hall on Thursday afternoon were laughing and joking a bit nervously, even conspiratorially, among themselves. Which is why when I heard what they were up to, my first thought was, "Does the mayor know you're doing this?" That's the nature of Baltimore's government — like the teacher in a classroom, the mayor pretty much has all the real power, and the council members, like students, basically have only the power of disruption.

The Baltimore County school board is asking the County Council to reallocate $1.2 million in this year's school budget so that teachers, administrators and nurses can get an extra few dollars a week to offset increased health care costs. Approval of the request would be a small step in smoothing relations between the county and school employees, who are upset that County Executive James T. Smith Jr. did not include cost-of-living pay increases for them in this year's budget while making them foot more of the bill for health costs.

A petition signed by hundreds of state workers complaining about proposed increases to their health insurance costs was delivered to state budget officials yesterday as a small group of employees huddled in the rain to protest the planned charges. "They want to balance the budget on our shoulders," said David Harding, a computer operator in the Department of Health and Mental Hygiene and a leader of a union that represents some of the state's nearly 100,000 employees and retirees. "It's gone too far."

O K, Democrats, do what you must to craft a health-care package you can pass. I understand that the "public option" in the House bill, as promising as it would have been for cost control and competition, will have to go. Lose the "cornhusker kickback" that was added to win the support of Nebraska Democratic Sen. Ben Nelson and would exempt that state from big Medicaid payments. (Dare Nelson to vote no.) No, illegal immigrants shouldn't get coverage from insurance exchanges, even with their own money.

One of the most frightening financial burdens Howard County government is facing perhaps gets the least attention - the cost of future employees' retirement health benefits. Created by a change in federal accounting rules several years ago that require every state and local government in the United States to put aside cash for those costs up front instead of paying them as they occur, Howard's initial estimate of the county government's bill as County Executive Ken Ulman took office in late 2006 was a whopping $477 million.