Is health care an unsolveable problem? Charles Krauthammer thinks it might be--at least if we're expecting the finances to work out. In an op-ed in today's Washington Post, Krauthammer argues that the supposed cure-all for health-care reform money problems--prevention--costs more money than programs it purports to fix:
Think of it this way. Assume that a screening test for disease X costs $500 and finding it early averts $10,000 of costly treatment at a later stage. Are you saving money? Well, if one in 10 of those who are screened tests positive, society is saving $5,000. But if only one in 100 would get that disease, society is shelling out $40,000 more than it would without the preventive care.So what does that mean? "Prevention is not," Krauthammer concludes, "as so widely advertised, healing on the cheap. It is not the magic bullet for health care costs." Where does that leave us? In the past few days, doctors, health care policy professionals, and private citizens have been coming up ideas for health care that touch on more than prevention. Here are some of their solutions.
- Study Local Standouts A team of health care policy professionals recently took a look at the United States' 306 Hospital Referral Regions in a search for "positive outliers." Discussing the conclusions of their study in the New York Times, they argued that "effective, lower cost care is possible," and that the "various reform bills" being tossed about by Congress and the administration are headed in "the right direction." What's the solution? They say we should protect successful medical communities like the one in Cedar Rapids, Iowa, which used electronic systems for doctor communication to eliminate unnecessary, costly, and potentially harmful CAT scans. Citing other examples as well, their bottom line is clear: "We must [...] look at the communities that are already redesigning American health care for the better, and pursue ways for the nation to follow their lead."
- Build A Consumer-Driven System David Goldhill has a personal interest in this debate. In an Atlantic article entitled "How the American Health Care System Killed My Father," he presents his plan: a consumer-driven system with catastrophic insurance only, mandatory health savings accounts, and incentives for regular checkups. As for the typical threshold for "catastrophic" expenses, he writes, it is "far too low."
- Follow 5 Simple Steps Physician Paul Toffel has another plan, which he outlines in the Huffington Post. It consists of five parts:
- "Change the current 50 state patchwork of private insurance programs [...] to a national clearinghouse of private insurance choices" to increase competition.
- "Return health care insurance companies to the pre-1984 federal regulations that limited their fees to administration only."
- Move away from employment-based care.
- Meaningful tort reform.
- "Get all of the urban medical schools back to serving their local indigent populations."
Dr. Toffel, who previously worked in a teaching hospital, sees further benefits. "An added plus" to his plan, he writes, "is that our medical schools can get back to their teaching mission as best exemplified by the County USC model, while providing great training for our future doctors."