“It is doubtful that doctors and other medical professionals would voluntarily cut their own income (even if some of it is generated by profligate spending). Most doctors I know say they are not paid enough. Their practices are like cars on a hill with the parking brake on. Looking on, you don’t realize how much force is being applied just to maintain stasis.” Those are the words of a Long Island cardiologist in an essay he wrote in today’s Times. “What one person calls waste, another calls income.”
The problem is that people paying soaring health insurance premiums are ultimately the ones footing the bill for that waste/income—and the bill that we all pay down the road is an unhealthy population that doesn’t get much bang for the buck with its health care dollars. There’s also something inherently incongruous about the concepts of care and profits. We want good health care. The industry wants healthy profits. They’re very different goals, often pulling each other in completely opposite directions.
The battle for influence in how any reform occurs has begun, including more and more advertising, which helped kill reform the last time around. Not to mention the 350-plus former government staffers and public officials who now lobby for insurers, hospitals, and medical groups.
If the system allows for reform—and that’s a big if—we should be able to save significant money. The authors of a book called The Innovator’s Prescription have a bunch of ideas. And, as a Times editorial reads:
Some respected analysts suggest that as much as 30 percent of all health care spending in this country — some $700 billion a year — may be wasted on tests and treatments that do not improve the health of the recipients. If even half that money could be recaptured, the amount saved would be more than enough to finance health care reforms.
The most obvious way to cutting health care costs is to cut care that’s deemed unnecessary. Only lots of folks will argue about what is and isn’t necessary, especially when decisions come down to life and death. A couple of stories in Time explore interesting ways of trimming costs: the use of more data so that doctors can provide more effective care, rather than simply more care; a call for the end of fee-for-service “perverse incentives,” and a reinventing of the system, in which we would give doctors incentives for keeping patient costs down. Because ultimately, the healthiest patients are the least expensive ones to treat.
But many people are understandably freaked out by the concept of less care. A WSJ story looks at how the U.K. limits care through cost-benefit analysis (a.k.a. rationing). The calculations can be quite cold: The gist is that British government is willing to spend about $22,000 to prolong someone’s life for six months. If it costs more than that, the person probably would not get the treatment.
The trick to reinventing health care in America is making us healthier with less money. That’s reform we can all live with.