Congress can only outline goals

There is a limit to how much Congress can spell out in the current legislation about how to contain health care inflation. But over time, reformers will be able to save billions as we begin to let medical evidence show us where we can cut costs.

We know that our health-care system is bloated with waste--as well as fraud and abuse. And some of that waste is not just a waste of dollars; it can be hazardous to our health.

For example, Americans are over-medicated. Older Americans, in particular, often find themselves taking nine or 10 drugs prescribed by four or five different doctors; and frequently one physician doesn't know what another doctor is prescribing. We also over-pay for many of those drugs. The pharmaceutical industry now enjoys a 16 percent profit margin -- and the industry has been extraordinarily profitable for years. Patients, tax-payers and employers cannot afford to keep the drug industry in the style to which it has become accustomed. Meanwhile Pharma shells out twice as much on marketing and advertising as it spends on research.

Diagnostic testing has begun to create what some doctors call "an epidemic of diagnosis," which too often, leads to unnecessary treatments-- and the risk of the side effects that accompany these treatments. The volume of CT scans has doubled in recent years; as a result, physicians fear that Americans are being exposed to potentially hazardous levels of radiation.

In the June 1 New Yorker, Dr. Atul Gawande points out that the number of surgeries done in the U.S. has spiraled during the past decade. Yet, he observes, there is no data indicating that our health has improved as a result. Tragically, each year, more Americans die of complications following surgery than die in car accidents. What we don't know is precisely how many of those patients didn't really need the surgery in the first place.

That said, what we don't want to do is restrain patient access to valuable services and products. This means that cuts need to be very specific, using medical evidence to delineate which treatments will benefit which patients. We need to excise the waste with a scalpel, not an axe.

Congress cannot provide a blueprint. It would not be appropriate for legislators to wade into the weeds of medical science to try to determine where spending is excessive. With rare exceptions, they are not physicians. This is why both Senator Jay Rockefeller and President Obama believe that we need an independent panel of doctors and medical experts overseeing Medicare spending. Medicare reform will then pave the way for health-care reforms throughout the system.

Current legislation outlines broad goals. For example, the proposals on the table make it clear that we want to move away from fee-for-service reimbursements which reward health care providers as if they were factory workers on an assembly line, paid "piece work" for the quantity rather than the quality of the work they do.

The legislation also emphasizes paying more for primary care, and for better coordinated patient-centered care.

Someone should know the names of the nine drugs a senior is taking--whether they are redundant, and whether they are compatible. There is an excellent chance that she doesn't need all nine, and that, because she is older, she would be better off with lower doses. Yhis is just one example of how reform could lift the quality of care, while simultaneously lowering the cost.

But much of what needs to be done cannot be legislated.

We must change the culture of U.S. medicine. Both physicians and patients need to realize that, when it comes to healthcare, sometimes "less is more."

By Maggie Mahar  |  October 28, 2009; 11:30 AM ET
Share This: Technorati | Del.icio.us | Digg | Facebook
Previous: New delivery models will solve the cost crisis | Next: It seems to be all about access

Posted by: sjag1 | October 30, 2009 7:01 PM
Report Offensive Comment