The health care system has faltered, and while consumers are those most affected, it is up to them to turn the system around rather than relying on any government assistance or plan, agreed a panel of experts.

“The health care system is broken and we have to fix it ourselves,” said Joanne Disch, chair of the American Assn. of Retired Persons (AARP) board of directors. “Health care is inaccessible for many, expensive for most and fragmented for all.”

The aging population in the United States will test the health care system in the coming years as new technology and improved medications have increased life expectancy.

However, the cost of this could be staggering and those set to be affected the most are in the private sector, mainly employers and their employees.

“Illinois employers will double their health care spending in the next 10 years,” said Disch. “Overall we will see around $100 billion spent in the private sector on health care in that time period.”

Health care has become a serious domestic issue and will move to the forefront of the national debate in the next few years as politicians prepare for the 2008 presidential election. Most candidates are expected to reveal their blueprints or plans to solve the health care crisis, and while the panelists welcome the discussion, most fear the idea of a universal plan that would move insurance away from the private sector.

“Politicians talk about the ‘feel good’ issue of universal care and leave the impression that they want to give away health care for free,” said John Garven, health care policy advisor to the Heartland Issue. “We should not emulate states that destroyed private health care.”

The panelists pointed to The Kentucky Health Care Reform Act of 1994, which implemented a government-sponsored health insurance network that had the unintended consequences of higher insurance rates and lower coverage as many private insurance providers fled the state.

Garven favors an informed consumer-based health care system that would drive down cost through competition. He pointed to Lasik eye surgery as a prime example. It is not covered by health care plans, but its cost has dropped and the procedure itself has improved in quality because of the competition in the market to lure potential customers.

Clay Elward, benefits plan design manager for Caterpillar Inc. agreed with this assessment. In countries that do have a government-sponsored system it often breaks down into a class system that leaves many on the losing end.

“A universal plan isn’t wanted,” said Elward. “The UK has a government-based system and that has developed into a two-class system. The wealthy are on a good plan and are able to see good doctors while the rest are designated second-class and are sent to second-class hospitals.”

Debating whether a universal health care plan would work better has become a moot point anyway, because the real answer comes from health care users and their lifestyle choices, said Sue Podbielski, vice president and general manager of Unicare/Wellpoint.

“Sixty percent of health care increases in the last 15 years can be attributed to lifestyle choices,” said Podbielski. “We can’t wave a magic wand and expect to solve the problem with universal coverage.”

All of the panelists agreed that the most effective way to stem the rising cost of health care would be do engage users and educate them on their spending patterns.

“We have a system that has relied on third party payment,” said the Heartland Institute’s Garven. “People think that health care is free.”

Caterpillar insures 150,000 people worldwide and it has learned that the best way to cut costs is through preventive measures that help keep its employees healthy, said Elward.

“Our objective is not only to cut costs,” said Elward. “We could just lower our coverage if we wanted to do that. Our goal is to improve the health of our members. If our employees are healthy, we will get a better return.”

The panelists agreed that the only way to really do this is to change the behavior of users.

Employees should be monitored for making positive steps toward a healthier lifestyle and then rewarded for their achievements.

“Incentives are the only way to go,” said Unicare/Wellpoint’s Podbielski. “Studies show that without incentives less than 5 percent of employees embrace lifestyle changes. If your company secures incentives 45 percent (of employees) will jump on board.”

Penalizing users for making poor health choices is something that is often debated now. Some companies have begun to make smokers or overweight employees pay more as they are a greater health risk, while others have refused to do so over fear of legal ramifications.

“Some of our peers have begun to charge employees for being a smoker or having an unhealthy BMI,” said Caterpillar’s Elward. “We are considering this, but there could be a legal risk. Obviously, some of our peers believe this is a fight they can win.”

AARP’s Disch said that more outpatient clinics or non-traditional medical facilities, where costs are lower, need to be developed. Today, too many people go straight to the emergency room for non-emergencies like a cold. This inappropriate use of the system ends up costing insurance companies, and eventually their customers, millions of dollars.

If consumers are educated to understand the costs of health care and they see that their choices do directly affect their income, then they will begin to change their patterns, said Podbielski.

“We respond as consumers when it hits us in the wallet,” said Podbielski. “We spend on health care without knowing the costs. The process needs to be more transparent.”

The Heartland Institute’s Garven believes that as Health Savings Accounts (HSA) and Health Reimbursement Accounts (HRA) continue to increase, the more consumer-driven market place will help to correct the current problems.

“By 2012 we should see the perfect storm for health care,” said Garven. “We will have reached critical mass and we should see 35-40 million people with HSAs or HRAs. Hopefully that should swing the pendulum back.”

However, the rising rate of uninsured adults is a concern for everyone and not just those who cannot afford coverage, said AARP’s Disch.

“There are 1.4 million uninsured adults in Illinois,” she said. “But even those who are covered bear the societal costs.”