The Road Ahead: Healthcare Cost Containment

At the start of the year, I came as close to a New Year's Resolution as I am willing to get by planning some posts on political issues for the next decade.  I've written about cynicism and food security.  This month, I'm thinking about healthcare cost containment.

In the interests of complete transparency, my preference is for universal healthcare using a single-payer system.  If I were in charge, I'd shut down the current private insurance system, organize government ownership of American hospitals, and open government-financed clinics staffed by well-paid physicians and medical specialists for the provision of healthcare.  I am convinced that this would lower costs and improve care.  But I'm not in charge and I've given up hope that the majority of my nation actually considers healthcare a right and a common good that we must provide for one another.

Sigh.

Short of the Sassafras Takeover, we must engage in some cost control of the current multi-heahed hydra that is the American healthcare system.  I have some thoughts.

1.  Wellness Programs
Let's set aside the tyranny of nutrition and instead concentrate on teaching folks how to enjoy food made from things grown in the ground.  Let's make life-long fitness something we pass on to our children.  Let's concentrate on that old-adage that an ounce of prevention is worth a pound of cure.  And for the love of God, let's teach ourselves that just because big Pharma says our lives would be better if we take Drug X, doesn't mean we should immediately demand a prescription from our doctor.

2.  Evidence-Based Medicine
There is a lot of research that suggests treatment protocols for various diseases and disorders range so significantly in the United States that we are often providing care that is neither necessary nor recommended.  It may even be dangerous.  In short, because of the balkanization of the practice of medicine and our focus on physician-autonomy, we over-treat in so many regions of the country that we are spending billions treating nothing.  A recent editorial in the New England Journal of Medicine spells it out.  We could cut our healthcare costs by one-third if we would just stop over-treating people.

3.  Tort Reform
I am not convinced that tort reform will actually lower costs much.  I am convinced that physicians believe tort reform is necessary.  And we need physicians on our side.  So let's engage in setting some reasonable limits on the damages people can collect from suing their doctor.  At its best, this will help to reduce some of the backside-covering over-treating that doctors who fear lawsuits engage in.  And at it's worst, well, it won't make things any worse.

4.  Consumer Cost Control
People who do not pay for their health insurance benefits treat it as some sort of free service whose costs do not exist.  This is just ridiculous.  The frank reality is that employer-sponsored healthcare costs an employer at least $10,000 per year per employee (more if family members are also covered).   Healthcare economists agree that Americans who bear some costs of their insurance (paying  a share of their premiums and also reasonable co-pays) will become more responsible consumers; attentive to costs and cost-control.  Let's insist upon doing right by ourselves.   The predominant expert on this issue is Henry J. Aaron, a scholar at the Brookings Institution.  He has a lot to say on this and many other issues.  Read him here.

5.  Pass Obama's Healthcare Legislation
I was among the Obama voters who hoped that the President and Congress would come together to provide healthcare for the 45 million uninsured people in America.  I now realize that many of the 250 million of us who have insurance don't give a fig about those who don't.  I am profoundly disappointed in my nation.

The bill before Congress is imperfect.  But the Congressional Budget Office reports that it will lower costs over the next ten years.  It will cover some of the uninsured; it helps parents to provide insurance for their twenty-something offspring (thus keeping healthy people in the insurance pool and helping to lower costs); it creates some incentives for lower-cost insurance pools.  To be sure, it is only a start.  But it is a start.  President Obama made a strong case yesterday and the final push is on.  Failure this time will leave millions of people with nothing.  Contact your member of Congress and let them know you support the legislation.