The Best (and Only) Way to Cut Health-care Costs

Providence Journal
March 12, 2008

By Wendy Everett

There is often an unfortunate disconnect between the politics and the reality of fixing health care, and two events in recent weeks provide a stark case in point.

On the same day that the government projected that health-care spending will continue to outpace economic growth well into the future, presidential candidates Barrack Obama and Hillary Clinton locked horns — not over health-care costs but over the issue of universal access to health care.

What’s wrong with this picture? As crucial as universal access is, it’s not the whole answer to health reform. Indeed, universal access is going to increase costs — as Massachusetts is finding out.

The fact is, until policy makers, presidential candidates included, stop arguing about the fine print of universal coverage and turn their attention to controlling the costs of health care, health reform will not be sustainable.

What they should be talking about is how to reform the delivery of health care, particularly as it applies to the kind of chronic diseases like asthma, diabetes, hypertension and stroke that afflict more than half of all Americans.

The price tag for treating these diseases is staggering. Some 80 percent of the more than $2 trillion in annual health expenditures already goes to taking care of chronically ill patients. A recent Milken Institute study found that in 2003, chronic care cost the country $277 billion for treatment and another $1 trillion in lost worker productivity. And if nothing is done to halt the rise of chronic illness, the Milken study projects that treatment and lost economic output will rise to $4.2 trillion by 2023.

Yet much of this cost is avoidable. With preventive programs such as early screening and health counseling, many chronic conditions can be delayed or prevented, or managed more efficiently.

But despite our ability to contain the containable, our health care remains geared to sick care — providing costly treatments rather than keeping patients healthy. We pay doctors to remove disfiguring skin lesions but provide little incentive for regular screening or counseling to avoid skin cancer in the first place. Gastric bypass surgery is an increasingly popular option for obese patients, but where was the diet and fitness counseling before the weight problems developed?

It’s as clear as day that better prevention and management of chronic conditions are absolutely key to health reform. Keeping people healthy will save money and save lives.

So where in the din of disagreement over universal access are the presidential candidates on controlling costs through prevention and management of chronic illnesses? You wouldn’t know it from the debates or the headlines, but they are in sync, Democrats and Republicans alike.

A bipartisan consensus emerged last fall at a chronic-disease forum in Boston. The event featured a panel of health-policy experts from the top presidential campaigns, and they all agreed that the key to health reform is constraining costs by tackling the chronic-disease epidemic through prevention and management programs.

As Christopher Jennings, a top health-care adviser to Sen. Hillary Rodham Clinton, put it, “You cannot deal with the issue of coverage if you don’t deal with the issue of costs, and you can’t deal with the issue of costs of you don’t deal with the issue of prevention and chronic care management.”

Accomplishing this will require fundamental change in the way the system reimburses doctors and other primary-care providers, according to Douglas Holtz-Eakin, a former director of the Congressional Budget Office who is now policy director for Sen. John McCain’s campaign. “We have a system where we pay people to do things to patients instead of having them well,” he said. “We have to pay people for diagnosis, for prevention, for coordination, and ultimately for better outcomes.”

Dr. Rahul Rajkumar, a health-care adviser to Sen. Barack Obama, said that transforming health care through better prevention and management of chronic illnesses must be “a shared project,” with innovative thinking across the board, from payers to providers to patients.

It’s a shame that this bipartisan consensus has not gained political traction or public attention. In the heat of a campaign, it’s just too easy to trumpet for universal coverage rather than advocate wholesale change in the delivery of health care. The candidates and the media find it more compelling to focus on dramatic differences. But in the end, this critical area of agreement may be more important than where the candidates disagree.

So spread the word: There is a bipartisan route to real health reform regardless of who is elected the next president of the United States.

Wendy Everett is president of the New England Healthcare Institute.

Link to Full Article: http://www.projo.com/opinion/contributors/content/CT_everett12_03-12-08_GE9…