Top priority: control costs
Published 4:29 pm Friday, July 24, 2009
The details of health-care reform are so complicated, the ramifications so broad, that even the experts have trouble grasping them. But this much is clear: If crippling increases in health-care costs aren’t slowed dramatically, the other major goal of reform — coverage for all Americans regardless of income, employment or pre-existing conditions — won’t be achievable.
Slowing the growth in costs over the long haul should be the major focus of the health-care debate, but it’s getting too little attention. Expanding coverage to all or nearly all Americans — and figuring out how to pay for it — is important, but the need for fundamental change that keeps costs under control is even more so. Again, if we can’t do the latter, we’ll never have enough money to pay for universal coverage.
Current providers of cost-effective, high-quality care are actively sharing what they’re doing right. Common among them is care that’s integrated and well-coordinated among a team of health-care professionals (often with the help of electronic medical records), with a priority on prevention and evidence-based treatments.
Hospitals and clinics that aren’t getting good results, either in costs or outcomes, also have similarities. Chief among them is a tendency to overtreat patients by ordering lots of expensive and often redundant treatments and procedures, which aren’t resulting in better patient outcomes.
In her excellent book, “Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer,” health journalist Shannon Brownlee reports that between 20 and 30 cents of every health-care dollar spent in the U.S. goes toward useless treatments and hospitalizations. There’s a whole lot of money out there to be saved.
To get there, health-care reform must fundamentally change the current payment system, emphasizing quality over quantity. Yet, as the reknowned Mayo Clinic noted 10 days ago on its Health Policy Blog, such changes are missing from bills that have emerged so far:
“Lawmakers have failed to use a fundamental lever — a change in Medicare payment policy — to help drive necessary improvements in American health care. Unless legislators create payment systems that pay for good patient results at reasonable costs, the promise of transformation in American health care will wither.”
President Obama has the right idea in his proposal for an independent commission of health professionals that would recommend just such policy changes annually. It would be modeled after the military base-closure commissions, with Congress either approving or rejecting recommendations in their entirety — minimizing political mischief.
The president is demanding a final vote on health-care reform this fall. During their summer recess, members of Congress will be gauging how their constituents feel about what’s on the table so far. We hope they come away with a clear No. 1 priority: get costs under control.
