MEDICAL MIRACLES CARRY HIGH COSTS

CAPE GIRARDEAU -- The chief executive officer of Missouri's largest health insurer says it's time for people to be realistic about the high cost of health care.

"The bottom line is, society has to begin to get realistic," said Roy Heimburger, chief executive officer of Blue Cross/Blue Shield of Missouri. "Our medical people can do absolute miracles. But they come with a cost."

While the cost of health care, and in turn health insurance, has risen dramatically in the past few decades, so has the level of care patients receive, Heimburger said.

"Thirty years ago, a baby born prematurely would require $500 to $800 worth of care," he said. "Today, that cost would be more than $200,000, but the difference is, today that child would live. I like to think of it as the price of miracles."

But while unplanned and often unpreventable health problems cost consumers some $325 billion annually, at least that much is spent on health care for diseases and injuries that are preventable, he said.

Heimburger said smokers and people who put themselves at risk of disease should be willing to pay for their lifestyles in terms of higher health care costs.

Eight out of 10 smokers will incur from $80,000 to $100,000 in medical costs in their lifetime due to the fact that they smoke, he said.

"Should society pay for that?" Heimburger said. "Or should we ask (the ones at risk) to pay for it?"

Heimburger said the attitude that "all are entitled to health care regardless of whether or not they can pay for it," coupled with skyrocketing malpractice insurance costs, uninsured patients and other factors has led to a national health care bill that reached $650 billion in 1990.

"Every person is entitled to (health care)," he said, "but it's at the cost of the general public."

Health care bills resulting from treatment of victims of violence and those incurred by the uninsured force hospitals to absorb medical costs, resulting in higher health care costs for other consumers, Heimburger said.

Meanwhile, health care premiums are also increasing. Blue Cross/Blue Shield of Missouri's premium income increased 21 percent in 1990, reaching $650.9 million.

The company paid just over $512 million in claims that same year, an increase of nearly 18 percent over 1989.

Nationwide, the company provides health insurance to 1.7 million people. It is also the nation's largest Medicare processor.

Increases in health insurance rates mean more of a burden for consumers and businesses that offer health insurance benefits to employees.

In an effort to deal with ever-increasing health care costs, some employers have looked to discount health care programs offered by Preferred Provider Organizations (PPOs).

Businesses that participate in PPO programs receive discounts when employees receive medical care from the PPO's network of physicians and hospitals.

Blue Cross/Blue Shield offers PPO plans to businesses across Missouri, but, so far, hospitals and physicians in Cape Girardeau have rejected the plan and similar ones offer by other insurance companies.

Heimburger said these plans "teach people to shop around for medical care."

PPOs allow patients to be treated at the lowest possible cost to both them and the insurance company, he said. The downside, he explained, is that many patients refuse to seek treatment from anyone other than their regular doctor.

"PPOs generally work best in a major metropolitan area, rather than a smaller area" like Cape Girardeau, Heimburger maintained. But he added that businesses in the area would likely realize some benefits from such a program.

Competition between the two hospitals in Cape Girardeau helps to hold down the cost of medical care, he said.