Health care hasn’t always been a controversial issue, but for the past couple of decades any discussion of how much we pay (and to whom) whenever we get the flu, go for a checkup, have a baby, or come down with a dread disease causes temperatures to rise (yes, pun intended). At “Inventing the Future of Health,” the conference agenda included topics: “Why does health care cost so much?” and “Health costs, Health quality: What’s data got to do with it?” While each conversation was potentially juicy (depending on how wonky you are), the conspicuously absent voice in the room was that of health consumers.

In other words, you.

Why do conversations about health care always sound like anything but discussions about our bodies and what we do with them? Yet your body, my body, and everyone else’s body is the simple bottom line of health services. Isn’t it time you asked yourself, What matters to me?

After all, a discussion of the future of health doesn't begin or end with the passage of legislation. The execution of laws and services evolves over time through myriad nitty gritty decisions about things like: Should people go to a pharmacy or a doctor when they need a vaccination? Should physician's assistants take up some of the workload from doctors? How many hospitals are needed? The details, as with everything, are endless... and important.

We, the (sometimes unwell) People

So, let’s look at some details that apply directly to you. These statistics come from the Health Care Cost Institute’s “2013 Healthcare Cost and Utilization Report.”

  • For millennial women between the ages of 19 and 25, out-of-pocket spending did not increase between 2012 and 2013. While consumers spent an average of $800 per person out-of-pocket in 2013 (a 4 percent increase over 2012) women between 19 and 25 spent the same amount as the year before: an average of $662 out-of-pocket. The report says this was due to a drop in out-of-pocket spending on generic and brand hormone contraceptives. Going forward, then, it will be interesting to see if out-of-pocket expenses for young women remain “flat” or rise.
  • Antidepressants were the most-used generic drug class for young adult men.
  • In 2013, adult women, between the ages of 19 and 54, had higher levels of outpatient and professional service use than adult men. After age 55, men catch up and start to spend equal amounts on health services.
  • Young adults visited the ER more often than older people, but older people paid (slightly) more for their visits: ER visit spending averaged $314 per capita for older people, $310 per young adult.

Apparently, the true “face” of health care is you, sitting in a waiting room. And, bored by all this talk of dollars and cents, you are not alone.

“I have better things to spend and invest my time in than being an informed consumer,” said David Newman, an economist speaking at the conference and executive director of the HCCI, creator of the utilization report. “We want a simpler system that works for us and that’s what the system’s got to deliver for us.”

Many if not most people probably feel this way, yet, use the word "system" and talk about "the future," and the dialog instantly changes. Now we must (collectively) look ahead and imagine the system we want to create, think about how people will benefit from it, and most importantly, how we will pay for it.

"People who are truly sick need to be in a system where their care is coordinated in some fashion, that’s the only way they will get well," said Newman, before adding, "Most of the people in this room we’re the walking well. We need a very different system of care."

How do we parse out these separate populations — the very sick and the very well (and presumably the in-betweens) — and then provide the care they need? More importantly, how do we do this in a fair manner if, as Newman noted, 50 percent of health care spending is on 5 percent of the population?

"One of the things we have not acknowledged in the U.S. is how much of our health is really driven by what are called socioeconomic determinants," said Shannon Brownlee, Senior VP, Lown Institute. "It’s do you have a good job? Do you have access to good food? … Those are far more powerful than health care."

If health is a personal responsibility, is health care also one? Or is health care a right, a privilege, a product, a service, a need? Sometimes, Medical Daily believes, we seem incapable of thinking beyond two status quo responses: “let’s do it more like Europe” versus “let the market take care of inefficiencies.” Could there be some as-yet-unknown, other way of doing things?

(Earlier this year at the WISH conference, Mark T. Bertolini, chairman, CEO, and president of Aetna, said: “The product people want is their doctor and their health system, not their insurance company,” while arguing for more community-based systems.)

Clearly, new ways of doing things are difficult to both imagine and support.

Affordable Quality

"Wellness programs, I hate to say, don’t work very well," Brownlee said. "There’s no evidence that these wellness programs really create much wellness or much savings." Instead, she would put money into primary care and community based care. Medical Daily wonders if people living in small, rural communities would get the same quality of care as people in big cities.

"I think we’re reaching a peak on what how much people can actually afford to pay for their healthcare once they’ve paid for premiums," said Newman, who strives for a more efficient way to deliver health care to people.

In the end, the one question the conference raised but did not answer was why health care is so expensive. What is known is that spending on health care continues to rise. A 3.4 percent increase in spend occurs annually, according to Newman who has been creating utilization reports since 2010. Perhaps, Newman did provide an answer to the cost question when he said,

"Every systemic saving that we achieve is a reduction in someone’s income." If lowering consumer health care costs means cutting someone's take-home pay, we can only bet that does not (and will not) happen easily.