Consumers should know who?s to blame for rising costs of health care

If you are reading this, then you are a part of the problem. Now that I have your attention, please read on.

Remember in 1992 when your health plan was a $250 deductible, 80/20 plan, and it did not matter what doctor or hospital you used? There were very few prescription drug cards and never an office visit co-pay.

Costs rose at an alarming rate. We wanted relief and fast. The providers and insurance companies got together and made deals primarily based on volume. Then we needed more cost control, so the providers wanted more steerage, or desire to use them, and the insurance company wanted bigger discounts.

Good in theory and it worked well for a while, but what really changed was how WE used our health-care plans. WE changed because WE wanted lower costs, and WE got better benefits for less money!

Now it is time to pay for that and WE are. However, the really tough part is changing our expectations and being responsible healthcare consumers. The "easy fruit" has been picked from the tree now we must do some pruning.

You don't expect your car insurance company to replace the car parts that are obsolete due to technology, so why do you think your health insurer should pay for the latest and greatest procedure or get the "magic pill" to cure your ailments?

Ten years ago, if you had a bad cold for a few days, you would go to the local pharmacy and buy some Nyquil, cough drops and Vicks VapoRub for about $10, but now, with insurance and co-pays, you can go to the doctor for $10 dollars and get a prescription for another $10 dollars. Guess what? You may have spent only $20 dollars, but your health insurance company probably spent $100.

Until we ALL begin making good, sound choices about our care, the cost will continue to rise.

Until we quit calling the doctor about the new drug we saw advertised during the game Sunday, the cost will continue to rise.

Until we remember that health insurance is a privilege and not an entitlement, the cost will continue to rise.

Until we change our expectations about our healthcare plans, the cost will continue to rise.

Until we learn to be more accountable for our own health, the cost will continue to rise.

Until each of us puts more thought into a decision to use the doctor than we do to go out to lunch, the cost will continue to rise.

When will the increases stop? When we can no longer afford the premiums, and I know some of you already are there.

And the question isn't just whether employees can handle rate increases for their families whether employers can handle the increases also is an issue.

It was announced a few weeks ago that the maker of Claritin was petitioning the FDA to make Claritin an over-the-counter drug. It will probably sell for $10 dollars, but its current average wholesale cost is $85 dollars for a one-month supply. Where is the logic in that? The patent is due to expire at the end of 2002, and its competitors' patents expire later. If they make Claritin an over-the-counter drug, then the maker of Allegra and other competitors will feel compelled to do so as well to maintain their respective market share.

Here is the catch. The maker of Claritin has a new drug coming out that is more effective and has the same active ingredient as Claritin called Clarinex. It is still under patent and will likely cost around $100 per month.

And they are betting that since the over-the counter-Claritin will be a lower dosage, it won't be as effective, so you will see Clarinex advertised on TV and you will call your doctor, who will say "Come in and see me." See the problem? $10 for the doctor, $20 for the prescription, and another $200 for the insurance company.

Total cost not including lost productivity, gas, etc., $230 vs. $10 for the over-the-counter medicine that was working fine until something new came along. Then your premium increases another $50 per month.

We must remember why we buy insurance. We buy insurance to have someone else assume the risk. The risk is the financial burden beyond our ability to pay.

If you can save $100 per month on your premium by changing the de-ductible from $0 or $250 to $500 or $1,000, and change the office visit co-pay from $10 to $20 or $30, would you do it? Do you realize you would have to have one claim in excess of $1,200 dollars or make 120 office visits to spend the same money? You no doubt have changed your car insurance deductible to save money, so why not use the same logic for your health insurance?

Most people don't want to change it because they feel they are entitled to it or that their employer should provide it. The reality is, we all eventually pay our own claims, so let's be sensible about how we do it. The time has come for us to develop reasonable expectations, think about our choices and become accountable for our own health.

(Mike Scott is an account executive with Barker Phillips Jackson Inc.)