PROVIDENCE – The public conversation about the unbearable cost of health care has been focused on an incomplete picture.

At the Nov. 24 forum, “Bending the Health Care Cost Curve, sponsored by the R.I. Public Expenditure Council and the R.I. Executive Office of Health and Human Services, we heard – once again – that the hospitals, insurance companies and government agencies are doing everything that they can to “bend the cost curve” in health care.

I am glad to know they are working so hard – and well they should.

The forum’s first panel featured David Blumenthal, president of The Commonwealth Fund, Chas Roades, chief research officer of The Advisory Board Company, and Ronald Smith, director of Legislative Affairs at the American Public Human Services Association, dishing on the national perspective.

A second panel, from the local perspective, featured Peter Andruszkiewicz, president and CEO of Blue Cross & Blue Shield of Rhode Island, Dr. Timothy Babineau, president and CEO of Lifespan, and Dr. Kathleen Hittner, the R.I. Health Insurance Commissioner.

The keynote address was given by Anthony J. Scerbo, from the Strategic Foresight for Complex Global Issues, a Washington, D.C., think tank.

The day’s events were introduced by John Simmons, executive director of the R.I. Public Expenditure Council, Steven M. Costantino, the secretary of the R.I. Executive Office of Health and Human Services, and Sen. Sheldon Whitehouse.

Missing from the discussion
However, like at most of the public events this year, there have been three major perspectives missing: consumers, behavioral health practitioners, and public health leaders.

Without real engagement from these three fronts, there is no way Rhode Island can even begin to “bend the cost curve.”

Much of the Affordable Care Act has been focused on how to pay for and streamline medical care, yet access to medical care only describes 6 percent of the major determinants of health.

The biggest determinants of health, some 37 percent, are related to individual behavior, such as smoking, alcohol and drug use, obesity, violence, accidents, suicide, and sexually transmitted disease.

Yet, as a nation, we spend 2 percent on prevention and 88 percent on treatment. How can we better integrate successful behavioral health and population health promotion interventions?

I know they are out there, and their leaders would add life and clarity to panels like the recent forum.

Here are some local examples:
• Shape Up Rhode Island, the online team approach to weight loss;

• Rhode Island Parent Information Network’s nationally-recognized approach to peer support for families navigating the health care system for family members with special needs;

• The health clinic at Central Falls High School, a collaborative effort to provide integrated health care to teenagers, bringing together the local community health center, the local hospital, the local mayor and the local school district; and

• Sankofa, an initiative to build 10,000 square feet of community gardens in the West End of Providence as a way to cultivate land, lives and community.

Behavioral challenges for hospitals, insurers
We all have a role to play in “bending the cost curve.” However, it seemed unfair to me that when insurers and hospital leaders point fingers at consumers and high utilization rates, there is no place on the stage for consumers, behavioral health or public health leaders to broaden the conversation, or ask hospitals and insurance companies to address their own “behavioral” challenges.

How are Rhode Island hospitals and health insurance companies addressing the massive expansion in administrative costs? According to the University of San Francisco, the number of hospital administrators has increased 3,000 percent since 1970, while the number of physicians has increased by less than 200 percent.

In order to justify his hospital system’s own hefty administrative costs, Lifespan’s Babineau presented data that Lifespan’s cost structure is on par with other leading hospitals across the nation. I would turn that around by asking: how are all of these leading hospitals working to cut out administrative waste?

Increase access to slow utilization
It is true that utilization rates are a major driver of the cost of health care for hospitals. Hospitals can only help those who come through their doors. If they are very sick by the time they walk in, up goes the cost of caring for them.

But, do we really want to reduce utilization? Don’t we want people to have access to the health care services that they need?

Rather than keep consumers out of medical care by creating health insurance plans with high deductibles and co-pays, we should engage population and behavioral health interventions to keep them from needing medical care.

And yet the speakers at the forum made no mention of partnerships with or support for consumer groups or public health and behavioral health interventions.

Let’s hear from consumers, public health leaders, behavioral health practitioners
In order to seriously address the cost of health care, we have to engage and fund behavioral health services and public health interventions to help Rhode Islanders make better choices and live healthier lifestyles.

Public events such as the RIPEC/EOHHS forum need to include consumers, behavioral health providers and public health leaders so that everyone can be held accountable for their role in the health care cost conundrum.

Babineau also shared the following equation: change only happens when the cost of the status quo is more expensive than the risks associated with change. He said: “We are not yet at that point.”

I respectfully disagree; the people I work with and who are in my community are clamoring for change.

Betsy Stubblefield-Loucks is the executive director of HealthRIght, an advocacy group for health care reform.