In an editorial yesterday, the Wall Street Journal argued that if the United States can implement policies that reduce the demand for -- and consumption of -- health care, we can reduce costs.
I don't disagree that reducing the demand for care would help to control costs; however, I do take issue with the Journal's assertion that creating more "individual responsibility for medical decisions" will completely solve our problems with excess demand.
Demand for health care (especially expensive care) does not begin with stepping into a doctor's office or filling a prescription. It comes from people needing care in the first place because they are acutely or chronically ill.
Most spending in our health care system is associated with patients with established, long-standing medical problems that require ongoing medical maintenance and intervention. Chronic diseases such as diabetes, heart disease, and cancer account for 75 percent of health spending in the U.S. -- and even higher proportions of spending in Medicare (96%) and Medicaid (83%). These diseases are responsible for two-thirds of the growth in health care spending since 1987.
It's not just a small group of Americans who are chronically ill. Today nearly half of Americans -- 130 million people -- need care regularly because they have chronic health conditions; many cases of which could be prevented or better managed.
An across-the-board increase in cost sharing borne by patients like these -- by increases in co-pays or cost sharing, as the Journal argues, is short-sighted policymaking. Increasing the price that patients face to reduce the likelihood that they will use health services may reduce health spending in the short-term (as in, patients may be less likely to see a doctor or fill a prescription), but will ultimately lead to more spending after their poorly treated illnesses render them in need of serious medical care or hospitalizations -- not to mention unable to work.
Spending for such patients is not reduced through reducing moral hazard but through effective medical management. Over 50 years ago, Nobel laureate Kenneth Arrow noted that when it comes to chronic illnesses, the debate about optimal cost sharing (balancing moral hazard and risk reduction) does not apply. In other words, the key to slowing the growth in spending is to attack its core causes -- the rising prevalence of disease -- which will decrease its associated costs.
Not to mention the fact that for all the "unnecessary" care that may be avoided by cost sharing, there are equally as many patients who may -- and already do -- avoid necessary care because of cost. Already, six in 10 Americans say cost forced their families to put off health care.
Today's Medicare program is an example of how -- even with high rates of cost sharing borne by beneficiaries (relative to private plans) -- costs remain high and outcomes poor. Medicare has high rates of preventable admissions to hospitals, and 20 percent of Medicare patients that end up in the hospital are readmitted within 30 days.
We are not going to solve this problem by continued increases in cost sharing, but instead by more effective care coordination and management before and after they leave the hospital.
By better managing chronic diseases, we avoid demand for costly procedures, such as amputations or surgeries that arise from untreated or mismanaged conditions. By preventing diseases, our system can avoid some costs altogether. The savings to both the health care system and the economy -- through improved productivity -- could be substantial.
The president and Congressional leaders -- on both the left and the right -- have rightly recognized that the problem lies in a misaligned delivery system in which Americans, insured or otherwise, aren't getting the right type of care to stay healthy and avoid costly procedures.
The solutions, such as improved care coordination and quality, will take some time to see the effects, but the result will be a radically different -- but ultimately more efficient and less costly -- health care system.
If something really is "unnecessary" (a canard if ever there was one), look at who is profiting. Hint: it's not the patient.
When insurers and their Congressional lackeys say "unnecessary," what they really mean is "it lowers our corporate profits to have to actually provide benefits, so we would prefer that people just die instead."
sorry, diet is NOT the answer to all our health care problems
C.M.G, PA-C
We need to move away from superspecialized medicine and back to looking at the body as a holistic system. Doctors need to be better educated on how to not only diagnose an illness, but also predict the potential outcomes of the treatment of that illness on other areas of the body. Sometimes it is better to NOT treat a condition than it is to try to treat the condition, when the treatment affects other areas, such as heart medications which when taken for long periods of time cause liver and kidney damage
Videotoxicosis is a major cause of doctor visits and lab workups. How many times have people seen a drug ad that describes a new disease on TV, suddenly exclaimed 'that's me' and did what the ad told them to - "Go ask your doctor about...." The advertisers know that if they convince people to go pester their doctors about wanting this or that drug, that a certain percentage will get it, regardless if they have the actual indications for that drug.
Those desperate for a 'cure' or better symptom control also fall prey to the advertisers as new drugs or treatments hit the airwaves and send them scurrying off to the doc to beg for this new treatment that promises the moon, at a price of course. Sadly, new isn't always better, but it almost always is more expensive.
I suggest an Office of Illness Prevention (OIP). It must be independent of: the food industry, the industry-controlled FDA/EPA/USDA triangle, Big Pharma, the medical community, the Surgeon General, the NIH, and even the herbal and supplement industries. It would conduct government funded university research into areas that have been completely ignored, such as using nature as a paradigm for health. I have personally already funded such research with great results. See my books: "The Wellness Project" or "The Original Diet – The Omnivore's Solution" for details. Ask your librarian to obtain a copy and you can read it for free.
The OIP would include an anti-revolving-door policy to avoid being compromised by other institutions. All of the research would be posted free to the world community, and there would be open dialog between consumers and the OIP via the web. New professional designations would be created for Illness Prevention Practitioners. Prevention should be part of a mandatory curriculum taught in every medical school. Ultimately, Illness Prevention would become a worldwide initiative, changing the face of health and health care as we know it.
Roy Mankovitz, Director
www.MontecitoWellness.com