Kent Bottles: Is It Really Impossible to Control the Cost of Health Care in the U.S.?

Anyone who has seriously studied the health care system in the United States knows that we spend more money and get worse results than many other industrialized nations.  The stalled health care reform legislation in the Congress has been criticized by some on the right for not controlling costs.  Medicare, which now pays for more than half of the health care delivered in the U.S. and whose lead private insurers follow, is slated to go bankrupt in less than 10 years if we do not make some real changes. Experts estimate that up to one-third of health care spending goes to waste.

This week Twitter made me aware of what three distinguished leaders in health care have to say about this important subject:  Toby Cosgrove, MD, Uwe Reinhardt, PhD, and Atul Gawande, MD.

In a Fortune Magazine interview, Dr. Cosgrove, the CEO of the Cleveland Clinic, stated, “There’s a dirty little secret, and I might as well tell you to start with. The secret is that regardless of what happens with health care reform legislation, the costs are going to go up.  We have more elderly people, and we can do more for them…We can really only try to contain the rate of inflation.” http://bit.ly/99WIxW

In response to criticism from a reader, Professor Reinhardt, the Princeton economist, explains why cost control in American medicine is so difficult.  “Unfortunately even the Pope could not achieve significant reductions in the cost of American health care over the next few years. To see why it is so, readers should replace the term ‘cost control’ in their minds with ‘constraining and possibly reducing the future incomes of doctors, hospitals, pharmaceutical companies, medical device companies and so on.’”  He goes on to say that given our system of governance where political contributions mean so much, “the task of constraining or reducing the incomes of American health care providers will be a long and arduous battle with powerful, moneyed interest groups.”

Reinhardt then goes on to convincingly show that the health policy solutions to rising health care costs will not work.  Business alliances, tort reform, buying insurance across state lines, and price transparency all have extremely limited abilities to bend the cost curve.  To cite just one example, the Congressional Budget Office wrote in a letter to GOP Senator Orrin Hatch that tort reform would “reduce total health care spending by about 0.5 percent.” (http://nyti.ms/9WaEjO)

Finally, Dr. Gawande writes in The New Yorker blog that he stands by the data he used in his now famous study of the high cost of medical care in McAllen, Texas. (http://bit.ly/LCSFU)  “The patterns of Medicare spending I found showed that McAllen’s medical community and culture did more – more surgery, more imaging, more specialist visits, more home-nursing visits – without clear benefit.  The lesson was that more is not necessarily better.”  Although critics of Gawande and the Dartmouth Atlas research that he used have tried to defend the status quo, Gawande concludes that, “none of the data used in the article has been found erroneous or wanting.” (http://bit.ly/cZ19kv)

We have to control the high cost of health care.  It is hampering our ability to have a strong economy, to create jobs, and to be able to spend money on education, defense, infrastructure repair, and the many other services that a strong America requires.  We have to do it, but controlling the high cost of American medicine will be difficult because one person’s waste is another person’s income.

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