Controlling Health Care Costs

Issues in Science and Technology, Summer 2008 | Go to article overview

Controlling Health Care Costs


Robert Louis Stevenson wrote, "These are my politics: to change what we can; to better what we can." Health care in the 21st century requires a change from old ways of thinking and doing business to better the lives of all Americans.

The articles by Peter Orszag ("Time to Act on Health Care Costs") and Elliott S. Fisher ("Learning to Deliver Better Health Care") in the Spring 2008 Issues are just two of the growing number of articles discussing the broken health care system in America. Orszag reports that the runaway costs of the Medicare program are attributed to the rising costs per beneficiary, not solely to the increasing numbers of older adults. Fisher rightly states that this increased cost, due to more frequent physician visits and hospitalizations, referrals to multiple specialists, and frequent use of advanced imaging services, varies across the country and does not better the lives of patients. Perversely, higher spending seems to lead to less satisfaction with care and worse health outcomes.

Fortunately, it is possible to improve the health of individuals, families, and communities while controlling costs. Congress is acting to immediately introduce legislation to improve the care that Medicare beneficiaries receive. For example, it is my hope that Medicare legislation that Congress intends to pass this year will include policies to improve the quality of care patients receive and increase access to health promotion and disease prevention services. Further, the Senate Committee on Finance has set an aggressive agenda of hearings this year to identify additional strategies for health care reform. As part of this series, on June 16, we will convene a full-day Health Summit to bring together health care leaders and Congress to explore viable strategies to improve the health of Americans.

The demand for health care reform goes beyond Medicare and Medicaid. The overall quality and cost of care must be addressed. Public and private payment systems can be tools used to obtain more appropriate health care while controlling costs. Payment should support clinical decisions based on the best available evidence, instead of irregular local practices. The judicious and appropriate use of technology will improve the lives of Americans and stimulate innovation. Because approximately three-fourths of the health care dollar goes to treating the complications of chronic illness, preventing disease and carefully managing chronic conditions are vital, and we should target the most expensive medical conditions first.

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In the 16th century, Richard Hooker wrote, "Change is not made without inconvenience, even from worse to better." This remains true in the 21st century. We know what needs to be done and how to do it. We have the political will to make the necessary changes. It will require continued commitment from all health care providers and payers to meet the expectations of the American public.

SENATOR MAX BAUCUS

Democrat of Montana

When it comes to health care, we all want the best. We want the latest, most sophisticated care for ourselves and our loved ones. We want the steady, unencumbered march of medical innovation that will bring us tomorrow's treatments, cures, and preventions. And we want this high-quality, accessible, and forward-moving care at a fair and sensible price. Once a year, most Americans make a price-driven decision about our choice of health insurance. Throughout the rest of the year, we don't want money to be a factor in the decisions made about our care.

The articles by Peter Orszag and Elliot S. Fisher present thoughtful perspectives in the ongoing debate about medical costs, quality, and access. The authors note the significant variations in the health care costs and practices across different regions of the country and point out that certain higher-cost practices do not necessarily translate into better outcomes. …

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