Honolulu Advertiser Second Opinion column by Cliff Slater

July 22, 2002





(1) Table showing HMSA plan costs changes 1970-2000. See also my earlier Second Opinion, Health care soon unaffordable. February 18, 2002.







(2) Transcript: Beyond the Patients’ Bill of Rights: Does American Need a New System of Medical Justice. AEI-Brookings Joint Center for Regulatory Studies. April 24, 2002.

 (3) A Brief Summary of Medical Savings Accounts of which an excerpt is shown at the foot of this page.  See also the Council for Affordable Health Insurance.

(4) See Three Cheers for the IRS. Editorial. Wall Street Journal. 7/2/2002.


(5) The author’s abstract discusses the results of a Rand Corp. study: “This paper compares the effects of obesity, overweight, smoking, and problem drinking on health care use and health status based on national survey data. Obesity has roughly the same association with chronic health conditions as does twenty years' aging; this greatly exceeds the associations of smoking or problem drinking. Utilization effects mirrors the health effects. Obesity is associated with 36 percent increase in inpatient and outpatient spending and a 77 percent increase in medications, compared with a 21 percent increase in inpatient and outpatient spending and a 28 percent increase in medications for current smokers and smaller effects for problem drinkers. Nevertheless, the latter two groups have received more consistent attention in recent decades in clinical practice.” Roland Sturm. DataWatch: The Effects Of Obesity, Smoking, And Drinking On Medical Problems And Costs. Health Affairs. May/June 2002.

(6) From the National Association of Health Underwriters. Key Stats on Medical Malpractice (from Jury Verdict Research; as reported in April 23, 2001 issue of Medical Economics).

 (7) Error: The average award $1million in 2000 not $3.5 million--See the American Medical Association News. See also The McDonalds coffee in the lap story.



(8) McGeorge School of Law, University of the Pacific. Explanation of MICRA legislation.

 (9) This legislation it is supported by both the American Federation of State and County Employees Union (AFSMCE) and the American Medical Association (AMA), whose views are available at their websites.






Reducing Hawaii’s medical plan costs

Medical plans have increased three times and prescription drug riders ten times over the last 30 years—even after allowing for inflation.(1) And it is going to get worse. What can we do? Here are three options:

First, let us all understand the economic principle that once the “ownership” costs of, for example, automobiles, health club memberships, or medical plan memberships have been paid for, the additional cost of using them is very little. This encourages their use more than if we averaged the ownership costs and had to pay each time we used them.

This principle is at the root of the success of Medical Savings Accounts (MSA's) now taking hold in the U.S. For MSA’s, companies buy catastrophic health insurance for their employees, which covers only those annual costs in excess of $2,000. This plan costs about half that of the premium for a conventional plan and the other half of the premum is paid into each employee’s MSA account. This employees use to pay all their routine non-catastrophic medical costs. Employees keep any remaining balances at year-end and can let it build up in their MSA account with all the same tax advantages as an IRA.(2)

Since employees with MSA’s keep the money they do not spend they are more sensitive to what they are being charged and this helps reduce medical costs for everyone.(3) The federal Kennedy-Kassebaum legislation allowing MSA’s the same tax deductibility as regular plans was originally limited to only 750,000 employees of small companies across the country but that limit has recently been removed.(4)

Second, medical plan costs could reflect the health cost differences between those members who live healthy lives and those who do not. For example, whether one smokes or not could be reflected in plan costs. Similarly, since a plan member’s degree of physical fitness and the degree to which they are overweight both correlate with the medical costs they incur, they could also be considered.

A basic rate for trim, fit non-smokers and an added premium of as much as double for overweight, unfit smokers would not only help reduce total costs but also encourage people to change to a more healthy lifestyle.(5)

Third, we could curb the extraordinary awards being made by juries in malpractice cases.(6) According to Jury Verdict Research, the average medical malpractice jury award rose almost 75 percent from 1995 to 2000 to an average of $3.5 million per case, with some awards going as high as $40 million.(7) Since one jury awarded $2.9 million to a lady who spilled hot coffee in her lap in a McDonalds, we should not be surprised.

Threatened by such huge awards, physicians practice overly defensive medicine, which results in much higher medical bills that would be case if there were some restraints on lawsuits.

California tackled this problem by passing the Medical Injury Compensation Reform Act (MICRA) which limits compensation for non-economic damages to $250,000. These damages are non-monetary losses such as pain, inconvenience, emotional distress and loss of companionship. MICRA still allows unlimited damages for economic losses.(8) Naturally, this legislation has reduced California medical plan costs.(9)

Unfortunately, Hawaii is the one state in the nation where these ideas cannot be implemented. Hawaii's Health Care Act does not allow MSA's nor can we charge differentially between those who choose to live healthy lives and those who do not—that would be discriminatory—nor can we limit court awards.

However, with Hawaii’s medical costs escalating by double-digit percentages annually, the legislature will have to make changes to allow new ideas. Otherwise we will face further crimping of our economy since businesses cannot absorb these cost increases.

Cliff Slater is a regular columnist whose footnoted columns are at http://www.lava.net/cslater