Healthcare Costs Run Amok

By Richard P. Holm, MD
 
The Patient Protection and Affordable Care Act, commonly called the ACA or Obamacare, could have been named the Access and Cost act. It was successful in “protecting patients” by guaranteeing access—making insurance available for more than 20 million people who were previously unable to get coverage. The second part of the name, “affordable care”, referring to cost, has not been as successful, however.
 
Politicians have correctly said: “Since the ACA was implemented, increases in health spending have slowed.” Personally, I do not find this statement reassuring when looking at the enormous cost of health care in the U.S. We spend $3.2 trillion per year for health care, which is twice the average cost per person than that of the next ten most expensive countries and more than five times the outrageous $600 billion we spend per year on the defense budget. Individual costs also grew during the last five years. Patient deductibles increased by 63% and premiums by 19% during a time when worker earnings grew only by 11%. 
 
From an October 2015 Commonwealth Fund Report comparing the U.S. with 13 other rich countries, the data indicates higher spending in the U.S. happens because of excessive use of medical technology and higher health care prices, while there were LESS doctor visits, hospital admissions or spending on social services. Despite all the health care spending in this country, we have poorer health outcomes, more chronic conditions, and shorter life expectancy. It’s like paying a high price at a fancy restaurant, expecting a perfect steak, and instead getting meatloaf.
 
How should we fix the healthcare cost problem?

1. Every patient should have and start with a primary care doctor or provider who emphasizes preventive care efforts and solid-science based quality parameters.
2. Doctors and hospitals should get more payment for efficiency and quality, NOT get more for doing more—specifically, more procedures and more expensive high-tech tests.
3. A single, nationally-interactive, easy-to-use, story-based electronic medical record system should reduce duplication and enhance coordination of care.
4. Improved social services should help all people, especially the poor, in avoiding inappropriate use of the ER while facilitating good treatment of chronic conditions.
5. Pharmaceutical reforms should allow marketing pressures and competition while encouraging honest research.
6. Medical management of the five percent of people who spend 50% of the health care dollar should allow better AND less costly care.

 
The ACA brought access. Now we need to control cost.