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The Prime Suspects
The Blue Dog Coalition is probably right. As is, the reform bill does not address cost-containment strategies. The truth is, if we don't deal with these cost drivers now, we'll certainly have to face them in a few years. Medicare is expected to go bankrupt by 2017, medical inflation is rising 7 percent a year, and cancer treatment costs alone are skyrocketing well beyond that -- having increased an estimated 267 percent from 1997 to 2004.
Many factors drive medical inflation, but some of the prime suspects include:
Expensive drugs/treatments. We need to improve clinical trial design to reduce the cost and time for drug development. On average, a new drug costs about $1 billion to create, test and introduce to market.
The practice of defensive medicine. In our current health-care system, physicians are given incentives to practice defensive medicine to protect themselves from liability. Unnecessary tests for patients means less time, less discussion and fewer resources that could otherwise be directed toward curing the ailment. A new system should encourage tools to improve clinical decisions, bring along the patient as a participant in care and protect the doctor's intentions to cure the disease.
Unnecessary/redundant services. We need coordinated care that rewards a health team for improved health outcomes in their patients. The current fractured reimbursement system, which pays for activities instead of performance, will continue to drive costs.
Emergency room visits for primary care services. We need to reduce emergency room services as a primary care option. Bringing coverage to more Americans will address this.
Administrative services. Health care encompasses a vast network of service providers, from primary care doctors, specialists and home health care to insurance carriers and pharmaceutical companies. Ensuring access to these services to all is not enough to constrain costs. A new system must remove administrative burdens such as needless tests, ineffective treatments and unfounded grievances. The system should support an information technology infrastructure that includes comparative effectiveness and health services research and rewards innovative treatments.
In addressing all of this, the practice of medicine must remain independent of political influences, be receptive to patients' needs, be worthy of the public's trust and be flexible enough to incorporate best practices and new procedures as they develop.
The new health care system's administrators also must reflect these traits as they reduce bureaucracy and improve efficiency. These benchmarks will ensure that the new system is in the best interest of the person it is designed to serve: the patient.
By
Doug Ulman
|
July 22, 2009; 5:32 PM ET
| Category:
Medicare
,
Primary Care
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Posted by: lensch | July 24, 2009 2:43 PM
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"The practice of defensive medicine. In our current health-care system, physicians are given incentives to practice defensive medicine to protect themselves from liability."
Many studies (including the CBO in 2003) have shown that even when severe restrictions are placed on malpractice suits, physicians continue to order test and treatments many consider as unnecessary. I don't know how to stop this, but it appears that tort reform is not the answer.
Most of the other items you mention will be extremely difficult to effect because of physicians' resistance to change.
You do, however omit, what should be one of the most important changes we can make in our system. A well run for profit corporation has one and only one goal--to make money for share holders. In the case of health insurers this conflicts with the goal of quality effective health care. They waste $400 Billion each and every year on high overhead and compliance costs designed to raise their stock price by lowering their medical cost ratios.
The reason we have so many different and complicated proposals is because the first principle of all of these proposals is to preserve the riches going to insurance company executive and shareholders. These proposals run 1,000 pages. HR676, Medicare for All, is 70 pages long. It gives quality health care to everyone. It solves problems like pre-existing conditions and like lose job=>lose insurance and since it picks up the $400 Billion mentioned above, it will cost no more than we are now spending, probably less.
Won't you help us support HR676?