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The Imbalance Between U.S. Healthcare Costs and Outcomes

Posted by Thomas Edwards on September 8, 2019 1:15 PM EDT
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Two recent opinion pieces featured in The Virginian-Pilot put a spotlight on the Medicare for All debate and the need for better outcomes....

....with the focus on improvements in quality healthcare and better health outcomes results.  The articles follow the traditional path of reviewing healthcare, either through the lens of the payment system (in one of the opinion pieces it was "Medicare for All") or in better results from the U.S. health care system given its world-leading costs. 

While neither article suggests that innovative and high-impact policies around helping the general population live healthier lives and become better healthcare consumers, each of them does suggest that the need to bring the behemoth of a health care system in control has to be more than "health insurance" or reducing health care costs through legislative pressures.

I'll give a very quick synopsis of the two articles, and suggest that while neither gets at the key points Joe's last blog spoke to, both suggest that things can be done better to improve costs structures and quality within the healthcare system itself.

The first of the articles was written by Jill Schlesinger, who is a CBS News business analyst, a former options trader and CIO of an investment advisory firm, leads with a strong attempt to explain the complexities of the Medicare system and how positioning it as the singular solution on the political stage is folly.   Much of the piece gives daunting statistical details relevant to today's existing focus and insured population and costs for Medicare.  When reading paragraph after paragraph of the details it left me with the distinct impression that simply adapting today's Medicare system to the overall general population would be ludicrous.  She explains that the various proposals that have been put forward have been grouped by the venerable Kaiser Family Foundation (KFF) into five general categories.  And survey-based research conducted by KFF suggests strong confusion among the American consumer public regarding the coverage of Medicare policies if applied to the overall public and the costs to be borne by all in the form of increased tax burdens on taxpayers and businesses.

In the end, Ms. Schlesinger does not suggest specific action or opinion on the issue.  She does conclude with the somber note of support for the idea that the Medicare Trustees "recommend that lawmakers take action sooner rather than later because the clock is taking on the ability of the country to manage this huge and important Medicare program".  That said, as a reader, the implication for me is that expanding and changing the existing healthcare system to be modeled after Medicare is quite a long shot.

The second article, also an opinion piece written by Dr. Bob Newman, a UVA Medical School graduate, and the US Navy veteran who has spent fifteen years in private practice in rural Virginia and seventeen years teaching family medicine.  While not a professional news person or writer, his argument struck a pragmatic and thoughtful chord with me.  Again, it was not a suggestion for reducing costs by decreasing demand on the health care system per se, but to improve patients's understanding of what can be done to prevent many disease states and to adopt actions to strengthen the outcomes of the health care system so better results will happen at lower costs.  Like Ms. Schlesinger's piece, there is much detail in building the argument that dramatic change is necessary because the excessive costs of the American healthcare system should mean better outcomes.  Many devastating ailments are preventable if patients have access to basic primary care and can get an early diagnosis and health improvement plans and services from their primary care providers.

Dr. Newman suggests several actions, that seem plausible and could improve costs by improving the redistribution of funding for healthcare by reducing the 20% of the $700 billion spent overall on healthcare on wasted, unnecessary services such as excess testing, imaging, and procedures.

Here are some other suggestions he makes in his article:

-There is an absolute need in costs transparency for all medical services prior to their delivery

-Insurance reform is necessary to control costs, including coverage for preventive services and reduced coverage for services that are not absolutely necessary or required-making these services payable by the individual patients' themselves

-Decrease spending on futile care at the end of life.

-An independent panel of health care experts should carefully study these complex issues over a year and deliver a strategic plan for the future of U.S. health care.

While both articles focus on a high-level view of the need to improve the cost-efficiency and outcomes-based effectiveness of the American health care system, neither suggest the sort of grass-roots application of bold population healthy living and smart consumerism that reduces the demand for healthcare as was proposed in Joe's blog post from earlier this week. 

In truth, given the trajectory of the aging population and the high cost and poor outcomes relative to these high costs of the American health care system, the ultimate solutions will require innovative work on both areas of focus.

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