Doctor's Orders
The current national debate on controlling health care costs has been called President Obama’s Waterloo.
But it’s really every American’s Waterloo as individuals and businesses struggle to stay above water in what we hope is a recovering economy.
While politicians and lobbyists try feverishly to pay for health care reform in Washington, D.C., the Commonwealth of Massachusetts is struggling under its own health care reform.
The Bay State’s health care program is celebrated and derided, depending upon whom you ask. But we’ll stick with what we hear from small businesses and those in the insurance industry who say that costs are still prohibitively high and are only getting higher.
Sen. Richard Moore, D-Uxbridge, and the team of leaders that recently proposed the Affordable Health Care Bill should be applauded for taking a step forward in defense of businesses that are struggling to make profits while also having to pony up for constantly inflating health premiums.
While the sentiment behind the bill is admirable, we don’t see it as having much traction.
Outlook Is Unclear
First, there’s the uncertainty at the national level as to what is going to happen with health care reform. The president is continuing his push to see reform passed, if not by August, at least by the fall. And while no one is sure exactly what will emerge from the swirling debate at the U.S. Capitol, it surely will have an impact on the Massachusetts health care system.
So, passing legislation here at home in haste seems short-sighted given that any effort may be supplanted by a federal mandate.
Also, the proposed bill doesn’t address a key issue in the health care debate: the role of the physician. We need to fundamentally change the health care system, which provides incentives for duplicative test and procedures because of the pay-for-performance model.
A recent and much-cited article by Dr. Atul Gawande in the New Yorker took an in-depth look at the reasons why health care costs escalate, and why they vary so greatly between one town and the next. By looking at Medicare spending data, he found the most expensive town in America to be sick: McAllen, Texas. There, the average Medicare reimbursement per enrollee is $15,000, twice the national average.
We decided to take our own look at Medicare data and reported in the June 22 edition of the Worcester Business Journal that the average cost per Medicare enrollee in the Worcester area is $10,248, exceeding both the state and national average.
Gawande, a doctor in Boston, argues in his New Yorker piece that one of the main drivers for cost is the pay-for-performance model used by insurers, which incentivizes more tests and more procedures.
We are not alleging that physicians are looking to make a quick buck. We know all-to-well how valuable our physicians are. But when a system is built around the idea that you get paid by the CAT Scan, the hip replacement, the bypass, chances are you are going to see an uptick in procedures.
The cheapest places in America for health care take a much more holistic approach to care, according to Gawande. He points to leaders such as the Mayo Clinic in Minnesota, where doctors work in teams to take care of patients. The focus is not on cheap care, but rather good care. The happy benefit is that duplication is taken out of the mix, reducing costs for everyone.
The reality is that health care costs a lot of money. And we as Americans, and as residents of Massachusetts, have come to expect a high-level of care. Waiting for a procedure is unheard of. And cutting-edge treatments are a given, not a bonus.
But at the end of the day, all this technology costs money.
The health care debate is going to continue on both the local, regional and national stage. We hope that the role of the physician isn’t left out of the discussion.
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