Consumer Directed Healthcare

by Michelle Andrews

Health care reform is no laughing matter, but MIT economist Jonathan Gruber’s new comic book on the subject aims to communicate some pretty complicated policy details in a way that, if not exactly side-splitting, is at least engaging.

In Health Care Reform: What It Is, Why It’s Necessary, How It Works, Gruber steps into the pages of a comic book to guide readers through many of the major elements of the law, including the individual mandate to buy insurance, the health insurance exchanges where people will be able to buy coverage starting in 2014 and how the law tackles controlling health care costs.

He ought to know. Gruber helped develop the Massachusetts health overhaul law and advised the Obama administration on the federal version.

Gruber says he was eager to write a book on the federal law because he believes people don’t like the concept of the overhaul because they don’t understand what’s in it. He points to polling that shows the public endorsing individual aspects of the law.

But the decision to do this in a comic-book style was his publisher’s. “At first, I wasn’t enthusiastic,” Gruber says. “I didn’t think it would be that effective. But the publisher said they had done a graphic novel about the 9/11 report. My son likes graphic novels, he’s 17. He said it’s a great opportunity, it’s a great medium. When you’re on a plane and they want to teach you what to do in case of accident, they hand you a graphic. I think it was the right call.”

Although the book is chockablock with optimistic predictions about what will happen under the new law, the chapter on cost control takes a decidedly more cautious tone. Noting that it was politically impossible for the new law to include provisions that could be guaranteed to “bend the cost curve” and control health care costs, Gruber’s character says the law took the best ideas out there about what might work and wrote them all into the bill.

He’s referring, for example, to provisions under which pricey health insurance plans, often called Cadillac health plans, will begin to be taxed in 2018, and to comparative effectiveness research to evaluate whether expensive health care treatments are actually more effective than cheaper ones.

As the title of his book suggests, Gruber is clearly an advocate for the law. But, he says, “I wanted to be intellectually honest. I believe that cost control is too hard for us to know what to do right now.” He cites two hurdles that must be overcome related to cost control: scientific, meaning we don’t know what works, and political, meaning we can’t always predict what will fly.

“I want to explain to that set of voters and readers who are really critical of this bill because it doesn’t do enough on cost contol that that is really an unfair criticism,” says Gruber. “We’re not really at a place where we could address that problem.”

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By Amanda McGrory

The newly launched IHT World LLC was created in an effort to counter the high costs of health care by offering custom packages for employer self-funded plans and using medical tourism and the Patient Protection and Affordable Care Act to help businesses cut their health care costs.

IHT World helps employees travel outside of the U.S. for nonemergency medical treatments where the quality of care is at least equal to that of the U.S. but the cost is much lower, the company says.

The combined medical costs, rehabilitation expenses, and travel fees for the patient and a travel companion are much less than the cost of the procedure in the United States, IHT World maintains. In the case of knee replacement surgery, for example, an employer could save approximately $15,000 on each procedure.

According to a PPACA provision, the premium rebate for a health insurance company should be at least 80 percent to 85 percent of premiums collected for health care treatment; however, if the insurance company does not meet the government mandate, the insured group could qualify for an yearly rebate from the insurance company. IHT World believes this could result in significant savings for both employees and employers.

“If American quality treatment is available, without the crushing prices, why wouldn’t you consider such a choice?” says IHT World President and Managing Director Pam Brammann. “When employers are presented with this new concept, especially businesses with employer self-funded plans, they are amazed that IHT World can significantly reduce their health care reimbursement costs without compromising quality.”

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