It seems to be all about access
I'll admit it...I don't know all the details of the health reform legislation. But then again, who really does? But from most accounts, it seems as if most of the measures are geared towards improving access and not reducing costs. Insuring all Americans is a worthy goal and we need to take the opportunity we have at hand to do it. But let's also acknowledge that current bills don't do enough to control costs.
Keep in mind that Congress, historically, has actually done little to control costs. In some ways, it has helped create a system, through its payment policies, that increases costs. For instance, reimbursement from Medicare primarily rewards procedures and pay for sick-care not health-care. It pays well for a colonoscopy, imaging study or balloon angioplasty, but not for the time to adequately explain why a test or procedure is or is not necessary, or how lifestyle changes can be just as effective as more expensive and invasive interventions. It has in the past helped cover the cost of training physicians irrespective of specialty choice and the need for particular type of physicians. These financial incentives have increased the number of procedure-based specialists, which in turn increases costs further. It's not surprising that more medical students want to go into dermatology, radiology or orthopedic surgery, which can pay two or three times in salary compared to internal medicine or family practice.
Fraud and abuse is another area that Congress has not done enough to control costs. Some estimate that medicare fraud has replaced drug trafficking as the number one criminal activity in Florida! Eliminating or at least reducing fraud and abuse could save more than $60 billion annually. Most would agree Medicare needs more tools and better policies to recoup this money.
Let's go ahead and get as close as we can to universal access. But then we do need to honker down and address long-term growth, and develop rational payment policies which ultimately will bend the cost curve.
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