Health Care Costs

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.

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.

It doesn't take a world-class bargain-hunter to recognize that the price of anything, from groceries to electronics, is impossible to assess without considering hidden costs. Like that big-screen TV? Better ask about the added cost of cables and digital sound. A home listed below market price can seem great - until repairs to the cracked foundation, faulty wiring and leaky plumbing are factored in. Yet for decades, the U.S. has embraced an energy policy blithely ignorant of the true price tag of driving our highways and providing electricity to our homes.

If you haven't gotten your open enrollment packet yet, brace yourself for higher premiums and deductibles, fewer choices and more pressure from your employer to eat your vegetables. Companies facing another year of rising health costs are shifting more of the burden onto workers while at the same time prodding us to lead healthier lifestyles to keep expenses from escalating in the future. Preliminary results of an annual survey by Mercer, a major benefits consultant, found that small to large employers estimate health insurance costs will go up nearly 9 percent next year.