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A Crash Course On Health Care Costs

BOSTON — At the State House, in hospital and insurance boardrooms, and in companies large and small, high-level discussions about how to deal with rising health care costs are underway. Now, the Greater Boston Interfaith Organization (GBIO) is helping consumers catch up.

About two dozen GBIO members are in training to lead a health care cost control campaign.

“God we give you thanks and praise…”

Twenty-four men and women, on folding chairs in a Roxbury church basement, bow their heads for the traditional start of any GBIO meeting. They’re doctors, employers and students — all are consumers worried about the rising costs of health care.

“At the end of the day, if the powers that be — government, insurers, providers — can’t fix this, then we have to look at what our political leverage points are.”
– GBIO President Hurmon Hamilton

“I’m very invested in making sure that cost control doesn’t sacrifice anything in terms of quality of care,” said pediatrician Jeanette Callahan, from Bethel AME church.

Dave Kidder, from First Church in Cambridge, joined the campaign because, “for the past several years, I’ve been in charge of buying insurance for the church. We found out this year that the plan we’ve had for several years is going to increase 17 percent.”

And Lucy Costa, a member of Old South Church in Boston, is “one of the beneficiaries or the new health care law.” Costa said she wants to make “that option continue to be available for me and others. We have to deal with rising costs so people can afford their premiums.”

These representatives of various churches, synagogues and mosques have given up 10 evenings since December to hear from the Massachusetts Medical Society, Partners HealthCare, Blue Cross Blue Shield and other leading health care organizations. These “students” hold 3’’ binders with Power Point presentations, their notes and homework.

Alliea Groupp, who co-chairs GBIO’s health care cost campaign, sets the agenda for Monday night’s meeting. “Where we are tonight is to take all those conversations and come in and try to figure out where we are in this, where we stand,” Groupp said.

She calls on Kidder, who is skeptical about the chances of both reducing costs and increasing quality.

“Do we all really think that that’s possible?” Kidder asked. “Have we repealed the law of ‘you get what you pay for.’”

“I really do struggle with that question,” Callahan said. “Coming up in medical school, we talked about the care of our patients and costs; we don’t even know how to think about those two things at the same time. I’m not kidding. It’s that simple.”

What doctors do learn, Callahan added, is to do all the tests necessary to make sure they don’t miss anything that might trigger a lawsuit.

Dr. Paul Hattis, the other GBIO health care co-chair, said research from the Dartmouth Atlas Project shows 20 to 30 percent of health care spending is wasted on unnecessary tests, errors or other care that patients don’t need.

“We’re both throwing money away,” Hattis said. “By doing the things we’re doing with that 20 to 30 percent of wasted care, we could be hurting patients through over-treatment.”

“There’s a lot of ideas on how to bring down costs, but none of them seem like they’ve been tested really,” said Celia Segel, a health care organizer. Segel suggests that GBIO focus on holding health care to the rate of inflation or some other benchmark.

The group’s lead organizer, Cheri Andes, jumps into the conversation.

“We would say, costs ought not to rise more than X percent a year, and we don’t care how you get there [hospitals, providers or the state],” Andes said. “We want you all to agree to hold the line at that. Would that be an interesting approach, and what would the line be?”

“We’d like to see it get down to 0 percent, or at least no more than GDP,” said Don Detweiler.

But Detweiler, from Temple Isaiah in Lexington, is worried about cost control measures that limit where patients can go or charge more for high-cost hospitals. He mentioned his wife’s loyalty to Brigham and Women’s.

“I can tell you my wife, who’s past childbearing age — I think I can say that, I hope,” Detweiler pauses while the group laughs. “She would never in a million years go to a small hospital to have a child. And I don’t think personally that people should be penalized to go to the institution that they choose.”

Especially, agree other members of the group, because these penalties will mainly restrict choice for low- and middle-income Massachusetts residents.

Keeping the right to choose where they go for care comes up again and again during the meeting. But these health care campaign leaders also talk about whether the state should regulate how much time a doctor spends with a patient, whether doctors should be paid based on their patients’ well-being and how patients should be held accountable for their own health.

“For a long time, consumers have taken a relatively passive role in the health care system,” said Valerie Zimber, from Temple Israel, “and it’s like begging us to become involved and advocate for ourselves because we are paying for it.”

GBIO President Hurmon Hamilton tells these health care campaign leaders they must be prepared to use political muscle.

“At the end of the day, if the powers that be — government, insurers, providers — can’t fix this, then we have to look at what our political leverage points are,” Hamilton said. That could be anything from “electoral power to maybe designing a ballot initiative like we did around health care reform.”

But first, Hamilton and the Greater Boston Interfaith Organization have to settle on an agenda and then take this intensive education in the arcane world of health economics and health policy to its 52 member groups. It won’t be, as GBIO leaders admit, a traditional, keep-it-simple, grassroots campaign.

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