Tom Campbell: We're paying too much for poor health care

Maybe it was a sign of how poorly news outlets inform us or perhaps it was just because we get bombarded with so much noise, but a significant recent story failed to attract much attention. Blue Cross Blue Shield of North Carolina (BCBS), the state's largest private health insurer, lost $497 million last year.

The 4.3 million BCBS customers in North Carolina, about one-third of the state's population, know what this means: Their health insurance premiums will increase.

Dr. Tunde Sotunde, CEO of BCBS, addressed the loss and spoke to the current state of our health care system. "Our system, as it currently exists today, practically is broken. It is too damn expensive. It is so complex, fragmented and inefficient."

He's right. Almost 18% of this country's gross domestic product, about one in every $5 generated, goes toward medical goods and services. We spend two to three times what other countries spend. Even worse, the U.S. ranks last among our peer-group countries in outcomes such as life expectancy, infant mortality and maternal mortality. Our life expectancy has dropped to 76.1 years, the lowest since 1996.

The day after the Blue Cross announcement, WakeMed, the private not-for-profit health provider and the one providing the most indigent care in Wake County, announced it was planning to form a "strategic combination" with Charlotte-based Atrium Health.

The reaction was loud and negative. WakeMed's CEO, Donald Gintzig, wrote an op-ed in The (Raleigh) News & Observer trying to justify the decision, saying that WakeMed "cannot on our own fund what is needed in the long term, nor do we have the borrowing power over the next 10 to 15 years to rebuild, expand and grow to meet the evolving needs of the community."

We've witnessed this consolidation trend for years. According to the Sheps Center for Health Services Research at UNC, at least 11 N.C. rural hospitals have closed or converted to more restrictive services. Our state has one of the highest rates of hospital closures in the nation.

Others have opted to join larger networks, including Mission in Asheville, Presbyterian in Charlotte, Baptist in Winston-Salem, Cone Health in Greensboro and New Hanover in Wilmington.

UNC, Duke and ECU's Vidant have taken over some hospitals. Atrium, headquartered in Charlotte, operates more than 40 hospitals in North Carolina, South Carolina, Georgia and Alabama. And Novant Health, headquartered in Winston-Salem, has 19 hospitals and 850 health care providers in North and South Carolina.

Providing care is increasingly expensive, but is bigger necessarily better?

Opponents of the WakeMed proposal fear the loss of local decision-making and increased bureaucracy. The assumption is that larger entities can affect economies of scale and operate more efficiently, but there are serious questions. The Atrium CEO earned more than $25 million last year. That money had to come from somewhere. Data confirms that patient costs increase and care for those without insurance suffers. And what about the quality of patient care?

We've watched community banks swallowed up by regional and national financial systems. The same is true with the media, transportation and travel, retail and construction. Experience demonstrates that bigger is not necessarily better. We lose the sense of community and local participation once enjoyed.

We need a timeout. Our health system is spiraling out of control and is well on the way to bankrupting insurance companies, care providers, and you and me.

Instead of losing our local hospital identities we should be exploring ways to strengthen them. For instance, insurance companies complain about dealing with inflexible, large care-provider networks, yet they provide reimbursements to them greater than those given to independent hospitals. The same is true with other vendors and suppliers. If ALL hospitals had the same costs and the same reimbursements, community hospitals could be more viable.

Until such time as they can conclusively demonstrate how you and I benefit from proposals such as the Atrium-WakeMed combination, it is time for a pause.

We need health care solutions, not necessarily larger and more complex entities.

We are tired of paying so much for poor health.