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Originally published October 6, 2012 at 4:00 PM | Page modified October 8, 2012 at 11:09 AM

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Op-ed: Individual responsibility in managing health-care costs

Guest columnist Ron Sims writes that the health-care debate ignores a crucial question: How much skin in the game should an individual have in managing his or her health?

Special to The Times

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THE health-care-reform debate has been conveniently reduced to whether we can we afford its costs. The price of care is important. However, this debate ignores a crucial question: How much skin in the game should an individual have in managing his or her health?

Unless we ask that question, we will remain embroiled in a health care debate without any true progress.

The discussion we need to have is how to hold individuals responsible and to engage them in their own personal health. How do we get people to start eating foods that are good for them, not just convenient? How do we create communities that encourage people to walk, ride a bike, run and swim? And for people with chronic illness, what role do they have in managing their conditions?

Federal, state and local governments, in addition to creating healthier and safer communities, can play a big leadership role in creating healthy communities and rewarding personal responsibility for health.

Individual responsibility for one’s health may seem radical, but King County employees, in partnership with the unions that represent them, are already doing it. As a part of King County’s nationally recognized Healthy Incentives program, each year employees take a written wellness assessment and complete an individual action plan to improve or maintain their healthy behaviors. Those who complete the wellness assessment and their individual action plan qualify to contribute less for health care cost sharing.

Under the current employee agreement for Healthy Incentives, employees are reducing costs to the public in four ways: They use health-care services less often; they pay higher co-pays; they choose less-expensive generic drugs; and more of them enroll in the Group Health plan, which his less expensive than the county’s preferred provider plan KingCare.

Over the past six years, King County has saved the taxpayers tens of millions of dollars by engaging employees in their health and health-care choices. In the proposed 2013-2014 budget, the county expects to save $14 million in health-care costs.

King County’s Healthy Incentives program can be a model for engaging participants in other private- and public-employer health plans, including Medicare and Medicaid.

I want everyone to have health insurance, but those who blithely ignore the consequences of their lifestyle should not be totally subsidized by those willing to manage their illnesses, eat well and remain fit. Individuals should pay a higher price for poor decisions and personal indifference.

Personal responsibility and accountability cannot be demanded of individuals without the tools to make educated decisions, such as publicly reported data on the quality and price of health-care services. We love our doctors, but having detailed data will help individuals determine if their doctors are providing value-based care. If not, employers should have the right to ask individuals to pay more for doctors providing subpar care.

That is why I am a strong supporter of reports such as the Puget Sound Health Alliance Community Checkup Report ( The reports identify high-performing physicians and hospitals that provide appropriate care with good outcomes.

For example, the Alliance report on hospitals can help health plans and individuals determine which hospitals have the best records of care — appropriate management of diabetes and heart disease, the lowest rates of hospital-acquired infections, duplicative procedures, and readmissions or extended stays caused by poor decision-making.

I also strongly support the push for cost transparency — not currently available in the Puget Sound region. Federal and state governments should require insurers to disclose the actual costs they pay to hospitals and doctors.

Are King County’s actual costs lower than those of Boeing, Alaska Airlines, Microsoft and the state? We don’t know. Yet all of these employers should be able to compare whether a hospital or doctor charges their insurance plan a higher cost for the same procedure than those of other employers.

In 2003, New Hampshire created the New Hampshire Comprehensive Health Information System, by statute, to provide information for consumers and employers on an interactive website called New Hampshire HealthCost ( The site compares the estimated amount that a hospital, surgery center, physician, or other health-care professional receives for its services. For an insured individual, HealthCost provides information specific to that person’s benefits coverage. It also shows health costs for uninsured patients.

There are no easy answers to the challenges facing health care. However, engaging individuals in maintain their health and giving them tools to select quality, cost-effective care are essential ingredients in the final solution.

Ron Sims has served as deputy secretary for the U.S. Department of Housing and Urban Development and as King County Executive.

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