Health care cost control – blowing smoke or being serious?

God love us, Maine, but when it comes to the issue of health care cost control we are so full of it here that if we shipped all the cost control B.S. elsewhere we could fit what was left of Maine into Connecticut. It all reminds me of the patient 70 pounds overweight and smoking two packs of cigarettes a day who walks into my office saying he wants to get his cholesterol under control; nothing personal, but call me when you get serious.

If Maine – and any other state – was really serious about controlling health care costs it would pass four laws the next time the state Legislature is in session. Those four laws are a primary enforcement of mandatory seat belt use (meaning a driver can be stopped and ticketed for lack of a seat belt), mandatory motorcycle helmet use, a ban on cell phone use while driving, and mandatory bike helmet use for children under the age of 16. Together these laws would save millions of dollars in health care costs, prevent many deaths and injuries, and make a powerful statement that Maine is hell bent on controlling health care costs.

You might think that Maine does not need these laws to prove it is hell bent on controlling its health care costs, with all that has gone on here in the last two years. Maine has a new state health plan, a governor and a Legislature dancing to the cost control tune, and employers and patients screaming about rising health care costs. It finally has the big health care political players – insurance, government, business, health care industry, doctors – all talking regularly about health care costs in forums organized by the health plan. That all sounds serious, right?

Well, maybe. The collective earnestness of these efforts, however, should give us all that same look on our faces that my wife has when I tell her I need a new power tool to complete that project for her, the face that launched a thousand quips. If we were really serious about controlling our health care costs we would be passing these four laws.

The unhelmeted and unbelted are collectively wasting millions of our Health care dollars every year. Consider a few facts;

. Only 60 percent of Mainers use their seatbelts regularly, one of the lowest seat belt use rates in the country. This is in part because a person must first commit another offense before a police officer can stop them and ticket them for not wearing a seat belt, so-called secondary enforcement;

. More than 200 Mainers are killed in motor-vehicle accidents every year, and thousands are injured. The costs to us all run in the hundreds of millions of dollars;

. A motor vehicle crash death costs society about $750,000;

. From 1995-2001, it is estimated that 850 hospitalizations of car-crash victims costing more than $20 million could have been prevented in Maine had all car occupants been seat-belted;

. About 12 Maine motorcycle drivers are killed, and 280 injured every year in motorcycle crashes. Head injuries to unhelmeted motorcycle drivers resulted in longer hospital lengths of stay (nine days vs. four days) and higher hospital costs ($33,400 vs. $14,600) than head injuries to helmeted riders;

. Only half of Maine motorcyclists involved in crashes were wearing helmets. Unhelmeted riders were three times more likely than helmeted riders to be taken to a hospital by ambulance, to be hospitalized, or to die as the result of a head injury;

. Cell phone use while driving makes a driver four times more likely to get in an accident. In fact, it has the same effect on driving safety as driving while drunk;

. Almost all hospital costs for injuries are born by all of us. More than 25 percent of those hospitalized have taxpayer-funded (that would be us) health insurance (Medicare or Medicaid). About 15 percent have no insurance, and if they cannot pay their bills hospitals must pass that bad debt cost on to other patients (that would be us). More than half have employers who pay their hospital bills via employee health insurance, and then pass those costs on to their customers (which would also be – you guessed it – us).

It is always argued that such proposals infringe personal freedom, and decisions such as motorcycle helmet use should be left to the individual. True, but they are small intrusions into areas already regulated, and exchanges for larger freedoms gained. The freedom of a person to go unhelmeted or unbelted infringes all our freedoms by spending our healthcare dollars unnecessarily. Moreover, in the current environment every dollar wasted on an unnecessary injury is really a dollar that must be cut somewhere else in health care, from a service needed by a poor patient, from a doctor’s ability to choose the best medicine for her patient, from somewhere. Wasted lives and wasted health care dollars are freedom lost.

In the next legislative session Maine needs A Bill to Prevent the Waste of Maine Lives and Maine Health Care Dollars that includes all four of these ideas. Our leaders should be leading the health care cost control issue by supporting these ideas, and cannot claim to really care about our health care costs unless they do. The Maine Hospital Association, the medical associations, the Consumers for Affordable Health Care, the Legislature and the governor ought to all pile on.

In the end the issue is not just these cost control measures; it is the entire issue of health care cost control. Passage of these ideas into law would say the state is serious about health and health care cost control, and the tone it would set for subsequent discussions. It would say to every health care constituency that Maine people are ready to sacrifice to control health care costs, so they must also. If my plea does not do the trick we all ought to be motivated by the fact that the next biennial budget is projected to be about $700 million in the red, and we need to save every cent we can in preventable, injury-related health care costs.

When Maine passes a primary seat belt law, a motorcycle helmet law, a ban on cell phone use while driving, and a helmet law for young bicyclists, I will believe Maine’s people and its leadership are serious about health care costs control. Until then, I don’t. Until then the health care cost control efforts from payers and patients and politicians and the health care profession and the health care industry are incomplete, and perpetuate our happy illusion that health care costs can be controlled without real sacrifice on all our parts. Until then we are not ready to do the heard work of controlling health care costs, because real health care cost control requires real leadership up front and real pain in the behind. Until then we are just blowing smoke.

Erik Steele, D.O. is a physician in Bangor, an administrator at Eastern Maine Medical Center, and is on the staff of several hospital emergency rooms in the region.