President Barack Obama said in his speech to Congress that the nation must address “the crushing cost of health care,” with premiums having grown four times faster than wages in the past eight years and one million more Americans having lost health insurance each of those years. Reform won’t be easy, he said, but it cannot wait another year.
We asked some health care experts, who have seen attempts at comprehensive reform founder over the years, what might make a difference this time.
We asked some health care experts, who have seen attempts at comprehensive reform founder over the years, what might make a difference this time.
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Elliott S. Fisher, a professor of medicine, is director of the Center for Health Policy Research at Dartmouth Medical School.
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In calling for reform, President Obama emphasized the critical importance of bringing the soaring cost of health care. To do that, we need to address the underlying causes: a fragmented care system; lack of accountability for the overall costs and quality of care; a payment system that rewards growth and unnecessary care.
Our research, documented in the Dartmouth Atlas of Health Care, shows there are remarkable regional variations in spending. Those differences suggest there are substantial opportunities to improve the efficiency of our health care delivery system while reducing costs.
For example, in 2005, per-capita Medicare spending was $10,988 in Los Angeles but $6,838 in Sacramento; $14,360 in Miami, but $7,008 in Tallahassee, Fla.; $12,119 in Manhattan, but $6,556 in Rochester, N.Y.
For example, in 2005, per-capita Medicare spending was $10,988 in Los Angeles but $6,838 in Sacramento; $14,360 in Miami, but $7,008 in Tallahassee, Fla.; $12,119 in Manhattan, but $6,556 in Rochester, N.Y.
If higher spending resulted in better care, this data would suggest that we need to spend more. But higher spending regions don’t provide better care. Ten years of research has shown that lower spending regions of the U.S. achieve equal or better health outcomes and quality. (Photo: Doug Mills/The New York Times) President Obama delivered his first address to a joint session of Congress.
The higher spending — and much of the growth in spending — is due to the provision of unneeded and sometimes harmful care: hospitalizations that could have been avoided with better primary care; frivolous specialist consults; overuse of diagnostic tests. Unnecessary care can be harmful because hospitals are dangerous places to be, especially if you don’t need to be there. And having more physicians involved in your care makes it harder to know who is responsible: too many cooks can spoil the soup.
Aligning those varying costs with better health results will take time. The stimulus package, which includes nearly $20 billion to invest in electronic health records, new research programs, and preventive care, will help — especially if the standards for electronic health records are linked to a requirement that all providers within a region adopt them.
President Obama, at least in the speech, was silent on some central issues: whether he would foster the development of a more integrated and organized delivery system, whether he would modify the payment system to encourage improved quality and lower costs, and whether reform will contain performance measures to reassure the public that lower costs are compatible with high quality care. He will have to answer those questions soon.
President Obama, at least in the speech, was silent on some central issues: whether he would foster the development of a more integrated and organized delivery system, whether he would modify the payment system to encourage improved quality and lower costs, and whether reform will contain performance measures to reassure the public that lower costs are compatible with high quality care. He will have to answer those questions soon.
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