Congress is not doing enough to cut costs
Congress has not come close to addressing the drivers of health care spending. We have to understand, as pointed out in Dr. Deborah Cohen and Dr. Tom Farley's book, "Prescription for a Healthy Nation" and former Surgeon General Dr. David Satcher's comment that over 80 percent of what drives health happens outside the health care system. How we design communities, price food, educate people, and create peer groups supportive of healthy behaviors will drive down health care spending far more than tinkering with health insurance coverage or negotiating lower rates with insurance plans.
When Congress intervenes in the health care system, the best thing it could do would be to support more integrated health care, with a focus on building community-based health care teams led by a trusted clinician in a medical home. The current legislative proposals are far too timid in moving in this direction. The President got it right when he mentioned great examples like Kaiser-Permanente, Intermountain Health and Geisinger in his health care speech to Congress in September. These integrated systems are most likely to reduce cost increases over time.
Unfortunately, the multiple bills passed through various House and Senate Committees do not go far enough to create a broad-based payment system that rewards integrated, low-cost, high-quality care. The fundamental flaw in all of these proposals is that they are based on the assumption that if everyone has health insurance, they will get more and better health care. However, health insurance access is not the same as health care access, and getting easier access to health care does not significantly improve population health. Until we make people so much healthier that they do not need to use the health care system as much, we will not reduce cost increases.
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