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Coverage and Cost
What's the single most important priority Congress needs to address vis a vis health care reform? Is this a trick question, or what? The two obvious answers are controlling costs or covering the uninsured, but trying to decide between the two is a little like answering the question, "When did you stop beating your wife?" Covering everybody without controlling spending will lead to rising costs. Controlling costs without covering the uninsured is simply unethical. Congress can -- and should -- draft legislation that does both at the same time.
The good news is, covering everybody is the easy part of the problem - at least in theory. All we have to do is find the money to do it. Of course, that's hard to do politically, as the heated debate over public versus private plans is demonstrating. The bad news is, controlling costs is really hard, because it requires making changes in the way that doctors and hospitals deliver care.
And getting a grip on spiraling health care costs is being made all the more contentious and confusing because many people - including pundits on op-ed pages -- keep making two fundamental errors in their analysis of the problem and its solutions.
First, many people assume that we spend a lot on health care because it's expensive. That might sound pretty obvious, but in this case "expensive" means "costly per unit of service." That would suggest that the way to rein in spending is by forcing hospitals, doctors, drug companies, CT-scan manufacturers and the like to accept lower prices for their goods and services.
Republicans want to let the market, and "competition," do the work, which usually means making patients pay more out of pocket and shop around for lower prices. (I can see it now: very sick patient sits up in hospital bed and says, "Just how much is that MRI going to run me?") Democrats, on the other hand, generally want Medicare to do the negotiating.
Regardless of who is trying to get the better price, the patient or the payer, price isn't our biggest problem. Sure, forcing prices down would reduce spending by a bit, at least temporarily. But it wouldn't address the more important driver of our gigantic national health care bill, and that's the huge amount of unnecessary, and potentially harmful care that patients receive - depending upon where they live.
Here's the funny thing about health care spending: the dramatic and relentless increases we've seen over the last three decades are due in large measure to the chaotic, inefficient, and often harmful way care is delivered in a handful of places in the country. One of them is McAllen, Texas, which some readers may know about from a recent article in the New Yorker. The Dartmouth Atlas, which many readers may have heard of, has pinpointed a dozen other parts of the country where we spend a lot and don't get particularly good care -- Los Angeles, for instance, downstate New York, big chunks of Texas, and Miami, and, unfortunately, the DC metropolitan area.
If we want to put a lid on costs, we need to go after excess spending in these regions of the country. Doing so will make it that much easier to find the money to cover the uninsured. My answer to the question about priorities is cost and coverage, which are a little like soup and sandwiches and love and marriage -- they have to go together.
By
Shannon Brownlee
|
June 8, 2009; 12:13 PM ET
| Category:
Health Care Reform
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Posted by: kaetc81 | June 16, 2009 2:03 PM
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Every one is trying to contribute to improve the economy and to help Americans...its time Big Buisness for got about profit and time for Insurance companies to put people first....
Check out their profits...roll back bonuses, (and I know they get them big time, I saw with my own eyes)...
They cover up what they truly get and say they cannot afford to give their employees insurance...they will say that until the end of time, AS LONG AS THEY MAKE THEIR PROFITS. they do not really care...That is why the American people but OBAMA in office, and he knows that...That is why he will be the ultimate decision maker...
Posted by: STANTONCAROL | June 14, 2009 8:51 AM
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do not side with big business and the insurance companies and pers drug companies.....side with the AMERICAN PEOPLE AND BARACK OBAMA .........THAT IS THE REASON HE WAS ELECTED...WHEN IT COMES TO HEALTHCARE IN OUR COUNTRY. AMERICA WILL MAKE THE PLAN WORK...WE WILL NOT LET IT FALTER...HAVE FAITH IN AMERICANS AGAIN. iF YOU FOR BUISNESS, PUT THAT ASIDE FOR YOUR FELLOW AMERICAN AND LETS GET THIS THING SOLVED.
Posted by: STANTONCAROL | June 14, 2009 8:47 AM
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This article highlights the problem without offering any solution. For what purpose then is the opinion of a "pundit", so named by the WP editors, solicited? Please write some suggestions for reform.--regards, WER
Posted by: werowe1 | June 9, 2009 8:36 AM
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The doctors and senior health care executive leadership and insurance companies have been conducting business with absolute arrogance against their patients and the citizens of the country. It's that simple!!! And all with the blessing of the administrations and congress.
Health care executives showed up at The White House to announce a $2 trillion dollar cut which was mere damage control because they can see the country is fed up. Let's make it hurt - cut $4 trillion!!
You can't get to single payor from here. There is too much data stored in too many insurance companies without having interim steps and interoperability. Maybe some day, but today we have to compromise somewhere away from where we are now.
It is time for "in your face" activism by the citizens similar to the 60's protests and we are not seeing it yet. The citizens need to take back the country and lobbyists and politicians should be quaking in their boots wondering what we will do next which is vote them the hell out of office after only 1 term!!!
How we got here is the "same ole same ole" of inviting the same talking heads to Congress and The White House.
The people need to mobilize and march!!!
Posted by: pgobe | June 9, 2009 6:51 AM
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The argument assumes insuring all citizens and lower healthcare costs are mutually exclusive. The system is ripe with low-hanging, potentially, obvious opportunities to shrink expense and improve care.
Examples:
Arrangements for 24 hour primary care and agreement to electronic medical record (EHR)standards can reduce emergency room visits by half (100 million visits annually) and cut national cost almost $250 billion a year.
U.S. administrative health overhead approaches $1 trillion per annum. Comparison with other, similar countries suggests $750 billion yearly savings is doable without adopting a 100 percent government delivery system.
Universal coverage eliminates the rationale for cost shifting now justified as a means to recover charity care cost.
Bundling services by diagnosis eliminates billing errors on an estimated 80 percent of medical invoices and encourages rewards based on better outcomes rather than quantity of service.
...And that's just the lowest hanging fruit.
Posted by: alportner | June 9, 2009 5:15 AM
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This is a typical response that points us in the wrong direction. Sure we have to control costs, but that's going to be hard. Nobody really has any ideas. There is the low hanging fruit of giving everyone Super Medicare (HR676) which will not cost us any more because of the huge savings we would get by the elimination of private insurance companies with their high overheads and gross demands on physicians and by lowering drug prices to companies that spend 3 times as much on "marketing" as research.
Posted by: lensch | June 8, 2009 11:53 PM
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The comments to this entry are closed.
It is impossible to "shop around" for services. First, you have to actually reach a person on the robot phone systems. Second, no one seems to know the cost of anything, it changes according to the whims of the provider.
Case in point, I needed testing, I did not have a primary policy only a discount plan; most if not all of any medical bill was paid by me. I tried for (4) weeks to get in touch with “THE APPROPRIATE PERSON” at (5) area hospitals to find out about cost, availability and insurance acceptance. Mostly all I got for my trouble was long phone waits ending with transfers, disconnects or messages that were never returned. They can't tell you because there is no set price, no transparency. I finally gave up. I called my physician who said to me, “sometimes I think I would be better off as a greeter at Wal-Mart, at least I would be able to do my job properly". He treated me without the tests. I can’t be proactive with my care; I can just put out the fires.
I have actually had to pay more for some things because I had the discount program! I use breathing inhalers, with my "discount" I was paying the co-pay and the contractual price set by the discount program which was considerably higher than just buying it without insurance!! If the palmist hadn't clued me into the scam, I would still be paying over 150% for my medication. I cancelled it, put the money in savings; I use it to pay my costs. If you aren't the insurance elite, you are going to suffer, period. Greed rules the system.
Insurance companies and hospital boards to me are greed personified, but they have good intentions right?
I feel my life will end earlier than it has to because I don’t have access to health care.
By the way, I’m a professional person who is caught in “perm/temp” limbo for over 20 years at a major electric company. Not everyone who is without care is uneducated or illegal; we are just caught in a corporate web that rewards them for cheating us. Without a public plan, people like me will still be without care and forced to pay for “discount programs” that are useless.