THERE ARE GOOD WAYS to restrain healthcare spending. And then there are ways that are you don’t even dare mention, not in polite company.
This column could be construed as coming awfully close to one of those bad discussions. It may even contain the “R” word.
A recent report by the Congressional Budget Office did a masterful job of avoiding that word, while pretty much defining it as a big part of the cost problem. The report, “Technological Change and the Growth of Health Care Spending,” concluded that about half of all growth in healthcare spending in the past several decades can be linked to changes in medical care resulting from advances in technology.
Technologies have provided many clinical benefits and resulted in longer and higher quality of life, the report states. “However, the added clinical benefits of new medical services are not always weighed against the added costs before those services enter common clinical practice,” it cautions. “Expensive services that are known to be highly effective in some patients are occasionally used for other patients for whom clinical benefits have not been rigorously demonstrated.”
The following paragraph struck me most – for what was not explicitly said: “These findings suggest that some medical services could be used more selectively without a substantial loss in clinical value. Research on comparative effectiveness could provide a basis for applying costly new technologies only when they are likely to confer added benefits that are significantly greater than the benefits conferred by less expensive technologies…. Attaining significant cost savings, however, may require difficult changes to the ways in which providers and patients make decisions concerning medical care.”
Described, but not said, is a mode of rationing.
Some 20 years ago, then Colorado Gov. Richard Lamm became a lightning rod for criticism by suggesting that rationing needs to be included in any discussion on restraining healthcare costs. Only four years ago, he was sticking to his guns in his book, The Brave New Word of Health Care. In it, he stated, “Health care is a fiscal black hole into which we can pour all of our children’s future. Yet we are no healthier than many nations that spend far less. Right now, we have reached a critical point where there has to be a whole new moral vision for the entire health care system – not just for individual people.”
The CBO report is pointing to the same conclusion – that the aging demographics of the country and the boundless capabilities of costly technology produce a scenario where costs can rise without restraint. Of course, there are many other factors underlying the nation’s $2 trillion annual healthcare cost, but this conundrum is one that plays a significant role in our inability to restraint healthcare spending.
We Americans struggle mightily with anything that appears to restrict our healthcare choices. We consider it almost an inalienable right to have a full range of choices pretty much whenever we want them, without a discussion of cost. We scoff at other countries’ healthcare systems, often blindly believing that long waits for care are the only way they can provide any level of care at that per capita cost. Often, those countries have just addressed cost and access issues that we have not.
What needs fixing in all this is a reorganization of the spectrum of care so that aligned incentives are in place, health is optimized and overall costs to the the nation are minimized.
Pennsylvania is crafting a system that rations its health dollars into prevention by helping patients manage conditions before they get out of control and put them in the emergency room or hospital bed. Under the plan, physicians and other clinicians will get financial support to redesign their practices and develop a more team-oriented system focused on changing patient behaviors. Rollout of the system, expected to take several years, is planned to begin in May.
That’s a rationalized system where a redesigned approach that uses formerly disconnected components to optimize people’s health and to make wiser overall cost-effective decisions about care choices. That’s a form of rationing we could all live with, and benefit from.