The Third Obstacle to Health Care Reform

Talking Points Memo (TPM)
May 13, 2008

We just are not getting good value for our health care dollars. This is why we need health care reform--not merely to control costs, but to lift the quality of U.S. healthcare.

Let me back up to explain that this is the third post of a four-part series titled "Obstacles to Healthcare Reform." In part one I suggested that we need to confront the Realpolitik of healthcare reform: the problem of getting the votes in Congress. This means facing the obstacles to reform head-on.

In that post, I focused on the first major problem: a lack of social solidarity. The French are willing to fund high quality healthcare for all of their citizens because they believe that nothing is too good for another Frenchman. Unfortunately, we do not feel that way about each other. In general, conservatives and people earning over $75,000 rate reducing the "cost" of health care as significantly more important than making sure that everyone has coverage. And many Americans are worried that reform will mean higher taxes.

In the second post, I acknowledged that they are right to be concerned about cost. The truth is that covering the uninsured and underinsured will be expensive, at least in the short term. Many people in this group haven't seen a doctor in a long time. Catch-up care will be costly. Reformers also recognize that we need to pay doctors and hospitals and doctors who take Medicaid patients as much as we pay those who care for Medicare patients. This, too, will be expensive. Finally, almost everyone agrees that we need healthcare information technology and that the government will have to help pay for it.

Long-term, reformers can reap enormous savings--if they use a scalpel (not an axe) to carefully excise the waste from our health care system. In a recent report aptly titled "How Many More Studies Will it Take?" the New England Healthcare Institute documents what the cognoscenti of the health care world have known for some time: about 30 percent of the $2.2 trillion that we, as a nation, spend on health care is squandered. When I talk about "cutting the waste," I am not talking about rationing needed care because it is too expensive. I'm underlining the need to eliminate unnecessary, ineffective and potentially dangerous care.

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