ObGyns, for example, would love to see professional liability reform because it would markedly reduce the cost of defensive medical practice. Many primary care physicians would love to be paid more and see specialists, such as orthopedic surgeons, paid less. And public health experts would like to see national efforts to reduce obesity and alcohol and tobacco use expanded.
Health policy experts have identified five reforms that will reduce the cost of health care. They have identified three others that will reduce the rate of rise in costs.8
To reduce today’s costs, those experts recommend that we
- implement a national electronic health-care record with significant decision support software
- improve management of chronic diseases, such as diabetes (10% of people use 70% of health-care resources)
- reduce waste in clinical systems and processes
- reduce futile health care at end of life
- reduce administrative costs by reforming health insurance processes.
To reduce the rate of rise in costs, we should
- cease fee-for-service payments and institute 1) bundled payments for an episode of care; 2) full capitation; and 3) patient-centered medical homes
- develop a national health effectiveness commission that controls introduction of new and costly medical innovations that only minimally improve public health
- reduce capital investments in hospitals and equipment through regulatory activity.
If these reforms do not reduce the rate of rise in the cost of health care, temporary price controls and indirect rationing of services are likely alternatives.
Are price controls and rationing unthinkable? Probably not: President Richard M. Nixon implemented price controls in the health-care industry in the early 1970s with only modest opposition.
Where is Alexander when he’s needed?
To repeat my earlier call: Is there a King or Queen of Health Care in the house who can solve the knotty problems of cost and access? Let’s watch and see who comes forward, and what they bring to the task. And tell us how you would prioritize health-care reform: Take the “Instant Poll” on page 8 and write to the Editors at obg@dowdenhealth.com.