Written by Bruce R. Copeland on September 09, 2009
Tags: actuarial, competition, costs, data management, health care, insurance, market, oversight, privacy, statistics, universal standards
I support health care reform. However I have reservations about the current health care reform package slated for vote in the Senate (as well as other health care reform proposals on Capital Hill from both parties). It’s not that I believe the bald-faced lies which reactionary conservative are leveling. Rather my lack of enthusiasm stems from the fact that none of these packages really address the critical underlying problems in our health care system—overly high costs and comparatively poor outcomes. I think many other Americans have the same reservations. So, what is missing?
Our health care problems are fundamentally data management problems. The first problem is that we do not have sufficiently comprehensive data on health conditions and costs. The second problem is that we have not had any MEANINGFUL actuarial oversight of health insurance companies for 25 years. These are data collection and analysis failures, and we MUST fix them if we are to fix our health care system.
We will not understand why our health care is so expensive and our outcomes so relatively poor until we begin collecting and analyzing comprehensive health data. Likewise we cannot expect meaningful competition in health insurance markets until consumers know the cost risks for different health conditions and can compare how different insurance companies cover those conditions.
Three principal factors have prevented us from collecting the comprehensive health care data we need: privacy concerns, insurance company resistance, and health care provider resistance. Privacy concerns should not limit our health data collection. Modern data management techniques make it trivial to cleanse health care data of personal identifiers. As long as we do not attempt to maintain extensive connections between different health treatment records for individuals, privacy protection will be maintained. After all it is the cost data and the overall health statistical picture that we are after. Insurance companies will no doubt balk at giving up data on health conditions and costs. They DO in fact own their own aggregation of the data, but they do not own your individual data or mine. If you or I or our elected representatives demand that our data be aggregated nationally, there is nothing any insurance company can or should be able to say other than to expect reasonable compensation for forwarding the data. Resistance from health care providers is a bit more complicated, but this too can largely be overcome if the federal government would demand that health care record software meet universal data standards. This would allow health care records to be portable between different health care office software packages and make it easier for providers to switch software, thereby improving competition in the health care office software arena. It would also simplify life for every patient by making their health care records immediately portable when they change providers.
Although most people don’t know it, actuarial oversight of health insurance companies is already mandated by law. The individual states require it. However for some 25 years, the states have been largely ineffective at actuarial oversight. The problem began in the 1980s with decreasing numbers of college graduates who had good training in statistics and probability, increasing demand for these same skills in engineering and science, and state budget cuts. The net effect was that state insurance offices were unable to hire enough people with sufficient statistical knowledge to do thorough analysis of actuarial models used for complex health insurance policies. The situation isn’t any better today. Nationalizing actuarial oversight doesn’t completely overcome these problems, but it probably leads to greater efficiencies and at least increases the chances that top statistical talent could be hired. Sensible legislation would go a long way toward fixing this problem.
Meaningful actuarial oversight at the federal level would do a great deal to encourage real competition in health insurance markets. It would, for example, guarantee that people who purchase catastrophic care policies are not subsidizing consumers who buy comprehensive health insurance. Moreover it provides the regulatory underpinning to support national health insurance competition. This would increase the number of insurance companies competing, and it would address the longstanding complaint from insurance companies that they have to satisfy too many divergent state requirements. Furthermore, it would significantly increase the pools of people insured in different categories, thereby putting insurance back on a sound statistical footing.
No health care proposal (conservative, liberal, Democrat, Republican, White House, Congress) can possibly achieve patient outcome improvement or cost containment unless it incorporates comprehensive health care data collection and effective actuarial oversight of health insurers. These are entirely appropriate (and by comparison inexpensive) roles for government. They guarantee that we have information essential for efficient functioning of our markets and they provide regulation that is already acknowledged as reasonable under state charters.
We ALL want to see better health outcomes and more reasonable health costs. I call on President Obama AND Congress to see to it that we get the MEANINGFUL health care reform we need, which MUST include comprehensive health data collection and actuarial oversight. You should do the same!