August 22, 2008-Fargo Forum Editorial

A symptom of national dilemma

Opinion - 08/22/2008 The tussle between Blue Cross Blue Shield of North Dakota and the state Insurance Department over premium rate increases is a microcosm of the broader national problem. In the mess that is the American health care system, it’s easy to find villains. It’s the drug companies. It’s the doctors’ lobby. It’s a do-nothing Congress. It’s malpractice lawsuits. It’s the insurance companies, including the Blues.It’s all of the above and more. But characterizing them as villains misses the larger dilemma. Health care inflation has been racing ahead of the general inflation rate for years and shows no signs of abating. The cost of delivering the quality of care Americans demand is extraordinarily high. For those who access the system because they can afford it or have good employer-provided insurance, it’s the best system in the world. But the real scandal is the estimated 45 million to 50 million Americans who are not insured or, for one reason or another, can’t afford even minimal health care.

As they do routinely, the North Dakota Blues have requested approval of rate increases for two categories of their plans. Insurance Commissioner Adam Hamm has denied one increase and is examining another. He’s in a testy face-off with the company about denial of the first rate increase. BCBS has asked for a hearing before an administrative law judge.

There is nothing new in a confrontation between BCBS and the insurance regulator. When Rep. Earl Pomeroy, D-N.D., was commissioner, he embarrassed and angered company officials by criticizing the company for holding board meetings in Hawaii. The board quit doing that. More recently, Commissioner Jim Poolman, who resigned to go into the private sector, infuriated company executives by demanding BCBS return to premiumpayers a portion of a company surplus. It did. Now Hamm has been critical of the company because, he said, it failed to provide complete information regarding a 14.8 percent rate increase request.

The BCBS story is a symptom of the national health care morass. The company wants to keep rates as low as possible, but must respond to rising costs of medical care. The medical sector struggles to maintain quality of care in the face of rising costs, diminishing Medicare and Medicaid reimbursements and escalating demand. Recent layoffs and program cuts at Fargo’s MeritCare and the merger of Fargo’s Innovis with a large regional hospital company underscore the intensity of price pressures impacting providers. Employers want to provide health insurance to their workers, but as the cost of a policy rises, many smaller companies can’t afford it, so more American families go uninsured.

Something’s gotta give. It won’t happen before the November elections, but when the new Congress meets next year look for health care reform to be high on the agenda. What form it takes is anyone’s guess at this point. But as the local health care landscape confirms, trends are unsustainable.

Forum editorials represent the opinion of Forum management and the newspaper’s Editorial Board