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By Heather Stauffer, Sentinel Reporter

Last updated: Monday, March 3, 2008 9:13 AM EST

Faced with burgeoning costs, growing gaps in coverage and a looming labor shortage, the local experts agree: Healthcare has to change, and soon.

“Basically healthcare for a family is the cost of a mortgage,” said Bets Clever, executive director of the Carlisle Area Health and Wellness Foundation. “They’re driven into very, very tough decisions.”

As the price tag for healthcare continues to outstrip the rate of inflation, Clever said, more employers are deciding not to offer insurance, and more people are opting out of what coverage is offered because they cannot afford the premiums. But even that only exacerbates the overall problem, she said, because the growing number of uninsured keeps driving up the cost of procedures.

“We can’t continue as we are,” Clever said. In studying the issue, she said, she has been persuaded that a graduate student whose thesis she recently read is right: Healthcare is a national problem, and needs to be addressed on the national level.

Sen. Pat Vance agreed, for a different reason.

“The federal government is now demanding uniformity in the way healthcare is delivered,” Vance said, citing Medicaid as one of the reasons for the trend. But at the same time, she said, there is no question that more and more of the costs are being pushed down on the states.

“That’s going to cause a lot of problems,” Vance said,, predicting whatever solution arises will be national. “By 2020, I think you’re going to see healthcare delivered in a very, very different way in Pennsylvania than you do now.”

Norman Epstein, the president and CEO of Summit Health, which also operates Chambersburg and Waynesboro hospitals, expects cost for health care to continue to rise. As Americans spend more and more of their wages on health care, economists are concerned about how health care is absorbing more money in the U.S.

“We have to see a decline in the rate of increase” in health-care costs, Epstein said. One way to encourage decline is to have the consumer pay a larger share of the cost.

“If you went into a supermarket and didn’t have to pay, you’d pick up more things,” he said. Consumers need to “be more discriminating.”

The cost of providing services has increased, but the demand for additional services has increased, too.

“How many people 10 years ago used a cholesterol-reducing drug?” Epstein asked. Now statins are much more common. “The amount of money spent (on prescription drugs) is massive.”

Problems now

“Health is a public and a private good,” said Jill Rumberger, assistant professor of public affairs at Penn State University. “It’s really a societal issue that needs to be responded to through legislation.”

Part of the reason, Rumberger said, is that the current situation is so complex and so close to crisis that it exceeds the scope of any other attempts to address it. In Pennsylvania alone, she said, serious problems include a large and increasing population of seniors; pandemic-like chronic illnesses such as diabetes and heart disease; and a growing shortage of medical personnel.

Vance expounded on that last item, noting that although there are waiting lists to get into nursing schools, Pennsylvania has developed a great shortage of nursing instructors.

“We could be educating more nurses if we had more instructors,” Vance said. She also noted that the welfare issue meshes in many points with the healthcare issue, and that when people talk about reducing welfare and medical assistance they don’t usually realize that the fastest-growing percentage of people in those programs are the elderly who have reached the end of their money but not of their lives.

“I’ve talked to a lot of seniors who said ‘I never thought I would live this long,’” Vance said. Although she said no one wants to talk about it, she expects the healthcare discussions will eventually have to focus on how much is spent on the end of life.

Epstein said that restricting choice in health care is a difficult issue. “Americans don’t want to hear someone’s going to make a decision for them.”

Proactive approach

Vance said she thinks the most positive change will come from an increased emphasis on wellness, which has gained popularity in recent years.

“I believe we could cut costs pretty dramatically if we focused on chronic diseases,” Vance said.

Cindy Small, Carlisle Regional Medical Center’s director of marketing and communication, confirmed that programs offering just such a focus have been in demand recently.

“One of our areas of focus is, ‘It’s your life, live it well,’” Small said. “The point of that speaks to how we really want people in our community to take charge of their health, and we want to be a partner with them to educate them and support them as they do that.”

Last year, Small said, the center was gratified to see its annual family, fun and safety event, which typically drew about 1,000 participants, attract more than 2,500. Like the swelling number of support and educational groups the center facilitates, that event demonstrated the community really was taking an interest in what was happening.

Even more encouraging, Small said, are the corporate wellness initiatives that have asked the center’s help. Those vary from yearly health assessments to screenings to preventative screenings to educational programs.

“We are also having discussions with the Greater Carlisle Area Chamber of Commerce regarding health initiatives we can offer in collaboration with business members of the chamber,” Small said.

Why they do it

One local company that has spent several years implementing a corporate wellness program is PMSLIC, which has about 100 employees at its Mechanicsburg office. Vice President Julie Burns said the company kicked off the initiative with a walking program that equipped all participating employees with pedometers and put them on teams, charting their progress on a wall chart depicting the Appalachian Trail.

“It was incredible,” Burns said. “You would see people take the long way around to the lunch room, walking at lunch, in the morning.”

Since then, she said, PMSLIC has kept up the health momentum with quarterly offerings focusing on different themes, such as how to handle stress around Christmas, how to prepare healthful and delicious meals or how to regulate blood glucose. Even though company employees are fully insured, she said, it isn’t hard to realize that preventative action is the smart thing to do, whether it be for individuals, companies or society.

This year, Burns said, PMSLIC has further increased those offerings, subsidizing the cost of gym and Weight Watchers memberships for employees.

PMSLIC’s efforts have not gone unnoticed. In 2007, Principal Financial Group named the company on its list of the top ten companies that are working to ensure their employees are ready for the future.

Principal’s healthcare specialist Jerry Ripperger said the industry is recognizing that wellness is becoming an inseparable part of healthcare.

“If you really look down to it and talk to the owner of a business, it’s likely the single best investment they can make,” he said. On a different note, he said, wellness provides a common ground on which insurance companies and their customers can agree, as neither wants to spend any more money on claims than they have to.

“There’s only so many years in a row you can walk in and deliver rate increases without something changing,” Ripperger said. “The solution is change the risk of their group.”

To that end, he said, Principal has been seeing much more acceptance of its portfolio of wellness programs recently, with clients using everything from risk assessment screenings to personal coaches.

Tammy Cornman, director of community health for Summit Health, said that attendance has been consistently high at events with free screenings, and people sign up on waiting lists to receive screenings.

In addition, certain programs attract more interest, including stress management and exercise programs. She said, “Folks have been a bit more interested in ‘How do I eat healthy?’ and ‘What kind of exercise should I get?’”

Handling change

Ripperger said he expects change to come, but that it will probably happen as it has in the past — on an evolutionary model rather than a revolutionary one.

Clever also said she wasn’t sure what the change would look like, but that she thought it would have to address issues of individual responsibility, as well as access and affordability.

“If you don’t approach it comprehensively, you’re not going to maximize the cost savings that we need,” Clever said, pointing out that the United States is the number one spender on health care but ranks only 35th in healthcare outcomes and expectancy.

Whatever the change looks like, Clever said she expects that Cumberland Counts is as well-positioned to receive it as anywhere else in the country. Low unemployment and high satisfaction with quality of life, as well as the presence of a variety of strong medical facilities, should see area residents through whatever happens, she said.

So, by 2020, will people be able to afford healthcare?

“Yes,” said Rumberger, in sentiments echoed by the others. “The real issue is, what will it look like?”