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Healthcare Efficiency
Explore the delicate balance of efficiency and quality care.
Getting it Right
Posted by:
Robert Burney on
September 27, 2009 at
11:20PM CST
In William Brody's first sentence, he nails the issue with healthcare in the U.S. "the escalating cost of care." He also identifies the biggest obstacle to fixing it: Congress. Lawmakers are much too vulnerable to lobbyists to make intelligent decisions. They value re-election above all else, and see campaign contributions as the key to that goal. I asked a Congressman directly last week if he would support price competition for healthcare services, as Medicare had tried to do for medical devices. He quickly pointed out that the previous effort by Medicare had disadvantaged a firm in his district, so he didn't want to try that again. Hard to tell a Congressman to do something that would cause him to lose both money and votes. That would require both leadership and courage. Next time you see those two traits together on Capital Hill, call me.
Brody talks briefly about drug costs and how generic drugs would be cheaper, if only Congress would allow Medicare to promote their use. And also about how Medicare patients are falling behind the curve as healthcare costs rise faster than Medicare reimbursements. One result is that practitioners increasingly refuse to accept Medicare patients (or any other insurance, but that's another story).
His remedy for this is, of course, to take Congress out of the decision-making arm. Let them appropriate money, but appoint another federal agency to make the tough decisions about how it is spent. He compares his idea to a Federal Reserve System for healthcare. Certainly, the failure of most city hospitals has come because the city fathers couldn't keep their hands off the tiller and out of the till. So, handing of management responsibility has some appeal. But somehow, I just don't see Congress agreeing to this. Not quite sure what the problem would be, but, you know, all that money, so close, . . . . And then some constituent would call to complain that they weren't getting enough reimbursement.
Actually, Congress isn't all that good at appropriating money either. They still haven't passed a budget for the government this year, so things will run on a series of continuing resolutions for awhile. The more serious problem in the long run is that Congress would just cut the appropriations for healthcare as a way to save money. That's what the Canadian government does, and then leaves it to local governments to run the healthcare system.
In the end, tho, he's absolutely right. "We must provide ways to effectively manage the costs of care." He might even be able to get wide agreement on that statement. Unfortunately, there is no agreement yet on how to bend that curve.
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