Ramone and Hilovsky: It’s time to reimagine health care in Delaware
Michael Ramone is a Republican serving Newark and Jeff Hilovsky is a Republican serving Millsboro in the Delaware House of Representatives.
The cost of health care is out of control. In the current fiscal year, the state of Delaware is spending nearly $2 billion on Medicaid and insurance plans for state employees and retirees — a $200 million increase over fiscal year 2024. Gov. John Carney has repeatedly called the growth of health care expenditures “unsustainable,” and he’s right.
According to the Bureau of Economic Analysis, in 2023, Delaware ranked dead last among all states for gross domestic product growth at -1.2%. We were the only state to experience a negative GDP growth rate.
In 2022, combined public and private U.S. health care expenditures accounted for 17.3% of gross domestic product, according to Statista. Our nation has the highest health care spending, as expressed by a percentage of GDP, among all developed countries.
If nothing changes, health care spending is expected to reach 20% of gross domestic product by 2031, with a total outlay approaching $7 trillion!
Commonwealthfund.org confirms that the U.S. has the most expensive health care system, while ranking last in outcome quality compared with six other industrialized countries (Australia, Canada, Germany, the Netherlands, New Zealand and the United Kingdom). Those outcomes were measured based on quality, efficiency, access, equity and the ability to lead long, healthy, productive lives.
The Delaware General Assembly has taken some positive actions. Earlier this year, lawmakers passed measures to improve access to maternal health care and reduce infant mortality. The impact of these initiatives will be monitored for several years to evaluate the results.
The U.S. is still a leader in medical research and the development of new treatments. Of course, these breakthroughs often carry steep price tags. As noted by the Peter G. Peterson Foundation, rising costs are more than offsetting our national genius for innovation by threatening the stability of the whole U.S. health care system.
Feeling the pressure to reduce health care costs, the General Assembly passed a controversial bill earlier this year that will give a government board oversight of private, nonprofit hospital budgeting. The supporters of this misguided proposal seem to have forgotten the business axiom that “you can’t cut your way to prosperity.” By ignoring the impact of pharmacy benefit managers and the cost of services provided outside the network — such as private lab services — many like us feel that expensive cost items outside the control of the hospital budgets were ignored. Potential consequences of failure to evaluate all issues will likely result in a questionable impact on the real causes of health care inflation and could further exacerbate health services’ availability in Delaware.
We believe it’s time to rethink our health care focus from a reactive system — treating illnesses after they occur (aka, “sick care”) — to one that is proactive and emphasizes “well care” and the prevention of disease when possible.
According to the “Impact of Diabetes in Delaware 2023” report, in the First State alone, 28% of all Delawareans are diabetic or prediabetic, and nearly 40% of residents are obese. Our state spends $1.1 billion annually on treating diabetes alone. Understand that diabetes is a linchpin disease for so many other common “metabolic” diseases, like hypertension, cardiac conditions, kidney and liver ailments, and even Alzheimer’s disease.
The research is clear. In most cases, Type 2 diabetes is reversible and curable if patients adopt modest lifestyle changes, such as eating healthier, reducing overconsumption, increasing exercise, getting more sleep, avoiding tobacco and minimizing alcohol consumption. Minor improvements in these areas, alone or combined, could profoundly impact personal health and our collective health care costs.
Positive societal changes can occur when citizens are motivated to act. Consider that, since the surgeon general first issued a warning in 1964 that smoking was hazardous, the habit has decreased by 73%. The American Cancer Society reports that, since 1990, death rates from lung cancer have been reduced by 54% in men and 30% in women.
We need to declare war on diabetes and the poor choices that lead to it and so many other bad outcomes. So, how does this work for diabetes care? As we live in a world driven by technology and advanced computer chips, technology is an answer. Companies exist to provide measuring and monitoring of baseline blood testing, glucose monitoring, body measuring, individualized diet and exercise plans based on lab testing, and comparative labs, all coordinated with a local health system and well-trained providers to move the needle on wellness. When better wellness is achieved and proactive measuring and monitoring are maintained, outcomes will improve, health will improve, and costs will be reduced.
We took the first step in implementing this vision by sponsoring House Resolution 32 in June, which calls for a public-private partnership to craft and test a pilot program to reduce the incidence of diabetes.
Curtailing the factors leading to diabetes will not only reduce its prevalence but also lessen the consequences of other diseases, like hypertension, heart attacks, kidney and liver illnesses, and Alzheimer’s disease.
If we just “move the needle” by 5%, Delaware will have healthier, happier citizens, and we will save the taxpayers $55 million per year. We are looking forward to working with the Department of Human Resources and providing updates as progress is made.
Reader reactions, pro or con, are welcomed at civiltalk@iniusa.org.
