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GEHB: Paying More for Less
- 1. GEHB Paying More For Less Healthcare
- 2. The U.S. Healthcare Environment
- 3. Healthcare Prices Experiencing “Great Moderation” 0% 2% 4% 6% 8% 10% 12% 14% 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 % Change In Healthcare Costs – 2000-2013 Total HC Spending Private Health Insurance Premiums Household HC Spending Source: Center for Medicare and Medicaid Services – National Health Expenditure Data
- 4. Trends Opposite Of What You’d Expect From Consumer Directed Price Lull
- 5. Before Current Agreement HealthChoice Experience Signaled Disturbing Trends
- 6. Hospital Admissions Declined 14% 19,719 20,041 19,381 16,723 2007 2008 2009 2010 # Hospital/MHSA Admissions (Salaried) 2007-2010
- 7. Outpatient Radiology Procedures Declined 23% 52,713 52,887 54,621 42,720 2007 2008 2009 2010 # of Radiology Scans (Salaried) 2007-2010
- 8. ER Visits Declined 19% 71,763 71,797 70,507 57,010 2007 2008 2009 2010 # of ER Visits (Salaried) 2007-2010
- 9. GEHB Hourly Utilization Experience Shows Identical Trends
- 10. Hospital Admissions Down 15% 7,028 6,169 6,052 5,980 2011 2012 2013 2014
- 11. Family Units With More Than Two Hospital Admissions Down 5% 379 326 341 360 2011 2012 2013 2014
- 12. ER Visits Dropped For Two Years 22,589 21,411 19,870 22,743 2011 2012 2013 2014
- 13. 2014 Spike in ER Visits Likely Due to ACA
- 14. Outpatient Radiology Visits Down 11% 18,966 16,241 16,840 16,824 2011 2012 2013 2014
- 15. Annual Specialty Declined Over Two Years 4.9 4.2 4.7 4.8 2011 2012 2013 2014 Annual Specialty Visits Per Family Unit
- 16. Overall Pharmacy Use Declining... 25.4 22.5 23.3 23.1 2011 2012 2013 2014 # Prescriptions Per Active Family Unit Per Year
- 17. ...Yet Employee Pharmacy Costs Increased 22%... $844 $946 $896 $1,032 2011 2012 2013 2014
- 18. ...And GE’s Pharmacy Cost Per Employee Dropped 11% $1,773 $1,355 $1,611 $1,608 2011 2012 2013 2014
- 19. Significant Cost Shifting From GE To Workers
- 20. Many More GE Families Meeting Annual Deductible 2011 2012 2013 2014 HCP 2,376 GEMB 3,842 GEHB 22,718 23,905 22,872 Total 6,218 22,718 23,905 22,872 # of Family Units Meeting Annual Deductible % of Family Units Meeting Annual Deductible 2011 2012 2013 2014 15.4% 56.4% 56.7% 54.7%
- 21. Many More GE Families Reaching Out-Of-Pocket (OOP) Max 2011 2012 2013 2014 HCP 25 GEMB 684 GEHB 7,434 8,434 8,090 Total 709 7,434 8,434 8,090 # of Family Units Reaching OOP Max % of Family Units Reaching OOP Max 2011 2012 2013 2014 2% 18% 20% 19%
- 22. GE HRA Program Doesn’t Work For Us
- 23. Account Balance Trends Initially Looked Positive... 2012 2013 2014 # Of Family Units with $0 HRA Balance 7,073 6,576 5,412 % of Family Units with $0 HRA Balance 17.4% 15.6% 12.9% Average HRA Account Balance $498 $730 $922
- 24. But Significant Money “Left On Table” Enrollment Level Conractual HRA Contribution OOP Spending (Pre HRA) Actual HRA Usage HRA Money “Left On Table” Option 1 - Single $600 $876 $70 $530 (88.3%) Option 1 – 2 person $900 $2,171 $570 $330 (36.7%) Option 1 - Family $1,200 $2,757 $793 $407 (33.9%) Option 2- Single $600 $670 $202 $398 (66.3%) Option 2 –2 person $900 $1,918 $480 $420 (46.7%) Option 2- Family $1,200 $2,609 $723 $477 (39.8%) HRA & Out-Of-Pocket Spending - 2012
- 25. HRA Usage Improved In 2013 – Significant Money Still Left On Table Enrollment Level Conractual HRA Contribution OOP Spending (Pre HRA) Actual HRA Usage HRA Money “Left On Table” Option 1 - Single $600 $902 $361 $239 (39.8%) Option 1 – 2 person $900 $2,297 $727 $173 (19.2%) Option 1 - Family $1,200 $2,890 $991 $209 (17.4%) Option 2- Single $600 $699 $278 $322 (53%) Option 2 –2 person $900 $2,072 $660 $240 (26.7%) Option 2- Family $1,200 $2,735 $929 $271 (22.6%) HRA & Out-Of-Pocket Spending - 2013
- 26. After Three Years HRA Accounts Still Underspent From 16%-50% Enrollment Level Conractual HRA Contribution OOP Spending (Pre HRA) Actual HRA Usage HRA Money “Left On Table” Option 1 - Single $600 $981 $354 $246 (41.0%) Option 1 – 2 person $900 $2,302 $725 $175 (19.4%) Option 1 - Family $1,200 $2,917 $1,004 $196 (16.3%) Option 2- Single $600 $710 $298 $302 (50.3%) Option 2 –2 person $900 $2,070 $664 $236 (26.2%) Option 2- Family $1,200 $2,897 $993 $207 (17.3%) HRA & Out-Of-Pocket Spending - 2014
- 27. Average Worker “Lost” $700-$1,000 In Benefit Enrollment Level Conractual HRA Contribution OOP Spending (Pre HRA) Actual HRA Usage HRA Money “Left On Table” Option 1 - Single $1,800 $2,759 $785 $1,015 (56.4%) Option 1 – 2 person $2,700 $6,770 $2,022 $678 (25.1%) Option 1 - Family $3,600 $8,564 $2,788 $812 (22.6%) Option 2- Single $1,800 $2,079 $778 $1,022 (56.8%) Option 2 –2 person $2,700 $6,060 $1,804 $896 (33.2%) Option 2- Family $3,600 $8,241 $2,645 $955 (26.5%) HRA & Out-Of-Pocket Spending -2012- 2014
- 28. Cumbersome HRA Reimbursement System Confusing to GE Families Worker goes to doctor Refuses to pay bill Doctor submits bill to GEHB GEHB declines bill (deductible not met) Worker attempts to pay bill with Wage- Works debit card WageWorks denies reimbursement(no bill is presented at time of debit card usage) Worker submits new doctor’s account statement to WageWorks WageWorks denies reimbursement (not an EOB with service dates) Collection company sends notice – threatens adverse action against credit rating Worker sends EOB to WageWorks – pays doctor from reimbursement account
- 29. No Insured GE Employee Should Get a $149,000 Medical Bill
- 30. GE Should Have Known Employees Typically Underspend HRAs
- 32. GE’s Three-Card System A Gamble
- 33. Plan Was Never Even Explained To Employees
- 34. Other Issues With GEHB HRA • GEHB HRA is medical only – Inclusion of dental/vision expenses allowable under law – WageWorks offers HRAs which have dental/vision coverage • Must spend balance while enrolled on plan* – Balance erased when you leave GE, switch to spouse’s insurance, or switch to Option 3 – “Spend-down” provisions allowable under law • FSA money comes first as a default – Unless employee’s elect otherwise, FSA money is exhausted before any HRA reimbursement * GE currently allows spend-down only if you turn 65 while still enrolled on Option 1 or 2
- 35. GE Families FSA Usage Rose Rapidly – Account Balances Starting To Fall 2011 2012 2013 2014 Total FSA Accounts 4,416 10,978 10,790 10,408 GE Families FSA Contributions $6,646,054 $15,791,123 $15,888,354 $12,511,210 Even With Rising Participation Less Than 25% Of GE Families Use FSAs
- 36. GE’s Costs & Our Costs
- 37. GE’s 2014 Insurance Costs 6 % Lower Than 2011 $402 $326 $370 $374 $16 $20 $20 $18 $200 $250 $300 $350 $400 $450 2011 2012 2013 2014 Total GE Healthcare Costs (Millions) – 2011-2014 Claims Less Contributions Administrative Overhead
- 38. On A Per-Family Basis, Company Costs Down 10% $10,350 $8,516 $9,268 $9,350 $0 $2,000 $4,000 $6,000 $8,000 $10,000 $12,000 2011 2012 2013 2014 GE Healthcare Costs Per Family Unit – 2011-2014 GE cost per family unit only increased 0.9% in 2014!
- 39. Is It Really Consumer Driven?
- 40. GEHB Claims For Pre-65 Higher Than Other Plans $10,882 $10,770 $11,269 $11,351 $9,292 $13,514 $14,304 $0 $2,000 $4,000 $6,000 $8,000 $10,000 $12,000 $14,000 $16,000 2011 2012 2013 2014 Average Claims Less Contributions Per Covered Family Unit – Pre-65 Retirees (Production) HCP GEMB HMO GEHB
- 41. GE Promised To Pay 76% Of All Medical Care
- 42. GE Families Paid 27% of Healthcare Costs in 2012 2012 Costs (GE Health Benefits for Production Employees) Estimated Cost Employee premium shares $67,800,936 OOP costs – Didn’t make deductible $15,346,320 OOP costs – Deductible, no OOP max $40,023,984 OOP costs – Made OOP Max $26,182,548 Less HRA deductions -$21,335,785 Total known Employee-paid costs $127,387,763 Total employer costs for GE Health Benefits $346,076,000 Known employee costs as % of total HC Costs 26.91%
- 43. GE Families Paid 25% of Healthcare Costs in 2013 2012 Costs (GE Health Benefits for Production Employees) Estimated Cost Employee premium shares $70,765,632 OOP costs – Didn’t make deductible $15,224,760 OOP costs – Deductible, no OOP max $40,668,001 OOP costs – Made OOP Max $29,875,417 Less HRA deductions -$28,021,798 Total known Employee-paid costs $128,512,012 Total employer costs for GE Health Benefits $390,388,000 Known employee costs as % of total HC Costs 24.77%
- 44. GE Families Paid 27% of Healthcare Costs in 2014 2012 Costs (GE Health Benefits for Production Employees) Estimated Cost Employee premium shares $84,245,464 OOP costs – Didn’t make deductible $16,540,184 OOP costs – Deductible, no OOP max $39,387,240 OOP costs – Made OOP Max $29,140,180 Less HRA deductions -$27,929,180 Total known Employee-paid costs $141,333,888 Total employer costs for GE Health Benefits $391,108,000 Known employee costs as % of total HC Costs 26.54%
- 45. UE Percentage Even Higher (Before OOP Is Even Considered) GE Average (2014) Local 506 (2014) Premiums $2,024 $2,235 Claims Less Contributions $8,930 $8,966 Premiums as a Percent Of Total Claims 18.48% 19.55% Total does not Include OOP costs, which were undoubtedly higher for Local 506 due to the higher OOP maxes of higher wage bands , but cannot be calculated with data provided to union
- 46. We Paid More Than GE Claimed 2012 2013 2014 Total Cost of GEHB $473,463,763 $518,900,012 $532,441,888 24% of Total Cost $113,631,303 $124,536,002 $127,786,053 Actual Employee Cost* $127,387,763 $128,512,012 $141,333,888 Difference $13,756,459 $3,976,009 $13,547,834 Number of Active Family Units 40,626 42,163 41,831 Difference Per Family Unit $339 $94 $324 Total In Extra HC Costs Over Company Projections $757 * Based upon partial GE disclosure of employee premium and healthcare spending
- 47. GE Falsely Continues To Claim We Pay 24%
- 48. Other GE Data Conflicts – Which Data Does GE Believe? Provided to UE January 2015
- 49. GE Claims That GEHB In 2013 Is As Costly As HCP In 2010 • “Company spend is greater now (beginning in 2013) than in 2010 under HCP” – GE union relations
- 50. GE Enjoyed Three Years Of 0% Net Healthcare Cost Growth 2010 2013 Change ($) Change (%) GE’s Insurance Cost Per Family Unit $9,283 $9,316 $33 0.36% Average Employer’s Cost Per Family Premium* $10,386 $12,489 $2,103 20.25% * Source – Kaiser Family Foundation – Family Premium Less Employee Contribution – Large Employers While Other Large Employers Paid 20.2% More For Healthcare
- 51. GE’s Cost Per Family Unit Since 2010 Only Up 2.9% 2010 2014 Change ($) Change (%) GE’s Insurance Cost Per Family Unit $9,283 $9,550 $267 2.88% Average Employer’s Cost Per Family Premium* $10,386 $12,742 $2,356 22.68% * Source – Kaiser Family Foundation – Family Premium Less Employee Contribution – Large Employers Compared to 22.7% For Average Large U.S. Employer
- 52. 2012 Switch to GEHB Brings Big Shift In Healthcare Costs GE Cost Per Covered Family -$1,856 -18.01% Increase In Cost For Each Covered Family $484 +18.24%
- 53. GE’s Industrial Profits Increased Substantially While It Enjoyed 0% Growth in Healthcare Costs $14.13 $14.07 $15.49 $16.22 $17.80 $12 $13 $14 $15 $16 $17 $18 $19 2010 2011 2012 2013 2014 GE Industrial Segment Profits (Billions) – 2010-2014
- 54. Survey Of Members Finds Widespread Dissatisfaction • 1,629 UE members surveyed – 94% - Would change medical plan if given opportunity • 83% said deductibles top reason • 60% premiums • 58% copays – 85% - Dissatisfied/very dissatisfied with monthly premium – 75% - Dissatisfied/very dissatisfied with drug copays – 74% - Dissatisfied/very dissatisfied with copays for office visits – 79% consider medical cost containment a strike issue
- 55. GE Under No Threat of Hitting Excise Tax $7,476 $8,904 $10,200 $17,317 $20,623 $17,832 $21,238 $27,500 2014 2018 (Proj) Excise Threshold (2018) HB1 Single HB1 2-Person HB1 - Family
- 56. Why Is the U.S. (And GE) Following A Failed Healthcare Model? All data 2012 unless otherwise noted U.S. OCED Average % Of GDP spent on healthcare 16.9% 9.3% % Of healthcare spending publicly financed 48% 72% Real health expenditure growth rate 2.1% 1.6% Real growth in pharmaceutical spending -1.1% -2.2% OOP expenditure on health per capita $1,045 (#2) $586 Practicing physicians (per 1,000) 2.4 3.1 Doctor consultations (per capita) 3.9 6.4 Average hospital stay (days) 4.9 7.1 Life Expectancy 78.7 years 80.2 years Infant Mortality (2011) 6.1 3.5
- 57. Return to HCP • Data shows substantial underutilization of necessary medical care • GEHB is too confusing • Confusion causes workers to leave hundreds of dollars in HRA benefits on the table • GE’s never paid its promised 76% of healthcare costs • Workers paying much more for less healthcare
- 58. It’s Not About Numbers, It’s About Our Families
Editor's Notes
- While the cost of healthcare continues to go up more rapidly than inflation, in recent years the speed at which the increase has happened has slowed. The Bureau of Labor Statistics has only recorded one year over the last decade where healthcare costs to consumers rose by more than 5% - in 2007 when inflation was also fairly high. And over the last ten years, the Kaiser Family Foundation found that the average premium increase for employer-provided family coverage never went into double digits, and only exceeded 6% once. In historical terms, we’re currently living through a slowdown in healthcare costs. Most notably, as shown above, the percentage of U.S. GDP spent towards healthcare has ceased to increase. In 2013, the Centers for Medicare and Medicaid Services (CMS) estimated the percentage at 17.4%. This meant no net increase reported in overall healthcare spending (when compared to spending across the entire economy) since 2009. Indeed, 2013 showed the slowest healthcare growth the CMS had ever seen – and it had been tracking healthcare cost growth since the 1960s. Here is a chart tracking healthcare cost increases over the last 13 years. Total healthcare spending across the economy, household out-of-pocket healthcare spending, and private insurance premiums have all been on a downward trend for over 10 years now. As you can see, they have all largely tracked one another closely. One notable exception was in 2010, when the stalled economy caused a decline in OOP healthcare spending. But since then there has been a close convergence between the three different forms of health care spending, as they all moderate.
- Health Care price growth has been modest in the last year, but utilization on a year-over-year basis is 5.7%. What is clear from the data is that healthcare costs are now staying down not due to falling utilization, but price moderation – which strongly suggests that consumer-directed care measures are a primary driver of cost moderation. ACA-Obamacare has caused doctors and hospitals to control billing to consumers and is obviously causing hospitals and drug companies to moderate costs. There is no evidence that programs like GEHB are significantly driving down health care costs, but the massive cost shifting GE imposed under GEHB may be driving down our members utilization of necessary medical services.
- The 2014 ER spike was unusual, but it was a nationwide trend. Due to ACA health exchanges, the expansion of Medicaid, and the introduction of individual health care subsidies which brought many low income people health care for the first time, the shortage of primary care physicians nationwide reached a critical level, forcing many to seek ER treatment for non-critical health issues. Undoubtedly, many GE families sought ER treatment because it has become more difficult in many communities to get timely appointments with primary care physicians.
- Initially, one could examine GE’s trends on HRA balances and conclude things are working alright. The proportion of family units with a $0 balance has slowly dropped, and the net HRA account balance has risen. But we have to go beyond this chart and look more closely at HRA data.
- But when you look at performance starting in 2012, you see a different story. The average out-of-pocket spending in all categories was high enough to exhaust entire HRA funds But average HRA usage was in every case lower than actual out-of-pocket spending. A quick look at this chart shows that the average GE family left anywhere from $330 to $477 per year in their accounts, even though their OOP spend justified a complete drawdown of their account.
- In 2013, we began to see slight improvements in workers usage of their HRA funds. Even though there was some improvement, workers still left anywhere from $172 to $322 in their accounts even though their OOP justified a full drawdown on HRA funds.
- 2014 showed only minimal improvements in actual worker usage of HRA funds. Workers underspent their HRA funds from 16-50% depending upon their plan option and the number of dependents.
- Overall, the average family unit left significant HRA money on the table from 2012-2014. This is a loss of $700 to $1,000 per GEHB enrolled family in Options 1 and 2. It makes absolutely no sense for workers to spend money out-of-pocket and instead rollover funds which the company could ultimately claim in the case of layoff, plant closing, or a decision to switch to Option 3 or enroll in a spouse’s plan. We strongly believe that this data suggests that GE families are confused by the bureaucratic nature of GEHB and HRA funds.
- In 2011, GE told us that the HRAs would help us pay for big new deductibles. But that hasn’t happened all the time. According to all industry data on HRA plans, employers are typically aware that workers will underspend their HRA. GE workers underused their HRAs and left more than 30% of available HRA funds on the table. GEHB’s HRA seems to be, technically, an Employer Pay First Plan, in that the HRA is supposed to cover the first portion of the deductible – although we know in practice the employee can end up paying first if they contribute to the FSA or if they just elect to pay bills out of pocket. Note that there are other HRA forms – Member and Provider pay – which have higher utilization. Provider Pay HRAs are clearly the plans with the highest utilization. Let’s take a closer look at how they work.
- We’ve heard from GE that a simpler HRA model cannot be instituted. But here is an explanation of how a provider-pay HRA works. This system allows the employee to spend down HRA money without submitting any paperwork at all. Also note that the plan design is offered by a division of WageWorks – the same company which currently administers GE’s HRA.
- This system doesn’t work. It’s cumbersome, confusing, and at times it appears like the oldest con game in the world – Three Card Monte. Last week, we complained to GE Health Care that workers prescription drug transactions aren’t showing up on the insurance company’s websites on a line-item basis. GE responded with its claim that the insurer is now updating its website and would soon offer line item statements of prescription drugs. Why did it take 3 years for GE to insist that the insurance companies give our members an accurate picture of their health care costs and claims history?
- Many members have expressed the view that they don’t know how to change the default setting so that HRA funds are drawn down before FSA funds are used.
- Because GE workers are paying so much more in deductibles and co-insurance than in 2011, enrollment in Flexible Savings Accounts has increased almost 250% beginning in 2012. Around a quarter of the workforce contributes to FSAs, both in an attempt to satisfy their OOP costs not covered by the HRA, and in some cases also to pay for some non-covered medical expenses such as dental. In 2014 the usage of FSAs dropped slightly in terms of total number of accounts, and more considerably in terms of the total contributions. We have no way of knowing why this decline happened. GE’s decision to establish a default spend of FSA funds prior to tapping HRA accounts actually penalizes employees who choose to set aside money.
- Oddly, the claims information for Pre-65 enrollees in GEHB shows very different trends than actives. We would expect that Pre-65 enrollees would have higher costs than actives, as they are older and presumably less healthy. But their claims per family unit are also higher than “legacy” pre-65 retirees who are still on HCP, GEMB, or HMO plans. This doesn’t make sense on the face of it - all things considered pre-65 retirees who retired after 2011 should be a bit younger than those who retired prior to 2011, meaning their costs, even if the plan design wasn’t different, should be lower. What gives here? The answer appears to relate to relatively low enrollment of pre-65 retirees in GEHB in general, which will be covered in more detail in our retirement presentation. With GEHB as the only option, the increase in total enrollment has been far less than the number of GE retirees collecting a pension would suggest, with almost half seemingly not covered by GE health insurance any longer. The healthier ones may be either forgoing health insurance, waiting until 65 to get Medicare, getting another job and utilizing that insurance, or going onto the coverage of a still-working spouse. The group left behind would be those without any other choices – which in many cases could include those too sick at age 60 to work any longer. Paradoxically, despite the high out-of-pocket costs for GEHB, it seems the exact “wrong” people are choosing to enroll, and GE is getting a sicker retiree pool out of GEHB.
- GE promised to pay 76% of all health care costs, but during this contact you’ve never paid that amount.
- A related issue with the 24% cost share is even if it was met, few of our members would actually see it. GE calculates this average across the entire workforce, which includes many workers on “competitive wages.” These workers presumably have similar claims histories to ours when they are a similar age. However, due to how the GE plan is structured, they pay lower premiums and OOP maxes. GE has given us information on the total enrollment, by wage band, enrollment status, and option, for Local 506. The average 506 member $211 per year higher than the GE average. 506 claims only $36 higher per year than . As a result, it’s clear that Local 506 paid at least 1% more toward insurance than the average across GE. The real gap was undoubtedly even larger, as the higher OOP maxes as you go up the wage scale mean our members would pay slightly more here as well.
- It doesn’t matter to GE that the figures it publishes are a pure fabrication. You’re 24% claim is a fiction, your own data contradicts this deceitful claim and yet the company continue to spin it over and over again as if the more times you say it the more credibility this deceit will have.
- GE’s own disclosed cost-share data differs subtlety from our own. The company included “other healthcare costs” - vision expenses – which are not related to GEHB. This pads company costs and lowers the Company spend percentage a little. The Company should also be aware that its 2014 projections which you provided to us in January 2015 didn’t pan out – the actual average GE family out-of-pocket was $88 more than you estimated. You also INCORRECTLY projected that GE would pay 74% of all health care when IN REALITY GE ONLY SPENT 72% in health care costs.
- When we add 2014 actual data, the Company’s cost rose 2.9% in the last 4 years.
- This statistic is chilling. In the first year of GEHB the cost shifting was massive. In 2012, our costs rose 18% and your costs declined by slightly more than 18%.
- 79% of GE workers consider a health care costs a strike issue
- There is currently no evidence that GE is in danger of hitting the excise tax. By our own calculations of GE’s healthcare costs – adding together total claims, overhead, and notational contributions to the HRA – the total cost of the plan currently is around $7,500 for single, $17,300 for two-person, and $17,800 for family. Presuming 6% inflation of premiums between 2014 and 2018 (which would be higher than GE’s recent experience, and even a bit high for average health insurance premiums) 2018 costs would be significantly higher, but still not anywhere near the excise tax. Unless we see a sustained return to double-digit increases, the excise tax is simply not going to be a concern, not only in this contract, but in the following contract either.
- Consumer-directed plans like GEHB will not make much of a dent in overall health spending. This is because 80% of medical claims are typically due to 20% of individuals. Those with chronic health issues will routinely have costs which exceed out-of-pocket maximums and deductibles, and will never be significantly reduced by becoming good health care consumers. Any attempt to bend the cost curve by focusing on reducing utilization, rather than reducing the base cost of care, doesn’t get to the root issue or the flaws in the U.S. medical system. These flaws are the same as those for GEHB in particular – we pay too much for too little care. Comparison of U.S. healthcare performance to other OCED (mostly developed) nations finds our system lacking. We spend nearly twice as much as the average country. We have far more private healthcare dollars sloshing through the system. Yet we pay the second-highest out-of-pocket costs of any country on earth (Switzerland pays slightly more). We actually get less care as well – we have less PCPs, we see them less often, and we stay in the hospital for shorter periods. And our health outcomes are overall below average when compared to the median developed nation. Finally, even though we are experiencing a significant slowdown in rising healthcare costs, the average industrialized country (starting from a cheaper base) is doing an even better job than we are today reigning in costs). The way forward on healthcare in the U.S. is clear. Virtually all other industrialized countries have either embraced nationalized healthcare, single-payer (nationalized health insurance with private providers) or a private system with government-set price controls. The movement towards consumer-directed care may achieve short-term savings for GE by driving down use of health care or by shifting costs onto our members’ back. But in order to deal with the real issues that make U.S. healthcare so expensive, we need to control costs, not merely limit utilization. We categorically reject the consumer-directed model. It’s bad for the nation and bad for GE workers.