May 1, 2008: 6:59 AM EDT
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'We all pay for the uninsured' (cont.)

By Geoff Colvin, senior editor at large

Is it going to be possible for consumers to get comparable data and be able to choose a doctor the way they choose a car?

I think it will be possible within three to five years. Important efforts are under way, with the collaboration of physicians, to agree on quality standards. There's collaboration in the industry for all health plans to pool their data to create very rich data sets. So consumers could look at a set of performance indicators that physicians think are appropriate, and be able to judge how their physicians fare.

Explain the strategy behind Aetna's introduction of an online system to provide medical information.

Every person should have a personal health record. I have a personal record. When I log on to the secure, password-protected site, I see the physicians, pharmacists, dentists - everyone who delivers care to me. I see all the tests and procedures that I've had. I see the lab values. And I can supplement that data with family history. If my mother, for example, had breast cancer, that's important for a physician to understand.

Many people think the last thing they want to tell their health insurance company is that their mom had cancer.

The industry was very careful in establishing standards. We have agreed that the data would be transferred from plan A to plan B only after the member was already enrolled in the plan, so the data could not be used for medical underwriting purposes or to deny anyone access to health insurance.

What about genetic information?

Our former CEO, Jack Rowe, helped us develop a policy, which the industry adopted, that we would not use genetic information for underwriting purposes. We also put in place reimbursement for genetic testing where the tests can inform the treatment. For example, if a woman has breast cancer, we will pay for the genetic tests associated with determining the type of cancer she has.

We may be on the verge of an age of miracles, but these new treatments could be very expensive. Is there a risk of a social crisis because not everyone will be able to afford these treatments?

If we're not careful, we're going to have a situation where people who have comprehensive coverage have access to everything, and people without have access to very little. So we have to focus on comparative effectiveness. Physicians and experts should study the science and reach a conclusion about what courses of treatment and technology give society a good payback. It's not necessarily a role we should have as insurance companies. But I think as a society we need mechanisms that help us allocate those dollars so everyone has access to something, and we don't invest strictly in high tech.

Health care is a tax-free benefit if your employer buys it, but if you buy it for yourself, you have to use after-tax dollars. Does that make sense?

No. I do not think it makes sense. We need to provide the same tax incentives to individuals to buy their own health insurance. It's also important to recognize that one of the biggest expenses a retired couple will have is health-care services. So things like health savings accounts, health reimbursement accounts, and special savings accounts will help people directly, or with the assistance of their employer they can set money aside to fund their co-pay and cost-sharing requirement. Tax equality in that regard is something we would support.

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