Heavy Lifting

Having passed a health care bill, Congress should be allowed a suitable time for gloating before the real heavy lifting begins. It has been common knowledge that the health care crisis has three main facets: access, quality and cost. The bill just passed addresses access to the system for most Americans; however it simply takes our broken existing system and applies it more widely. The CBO has been able to squeeze out some cost savings in this new plan by cutting reimbursement to Medicare providers by 21%. Office based physicians with a high overhead will find their actual pay reduced by about 50% by these cuts. They will begin opting out of Medicare--hence, making access a problem all over again.

The heavy liftings that I allude to are the quality and cost issues which this bill fails to address. Despite all the claims that we have the best health care system in the world, we do not. Numerous studies demonstrate that we lag significantly behind other developed countries in important quality indicators--yet we spend almost twice what they pay. Fixing the quality/cost (value) problem will look like the Aegean Stables after the relatively simple process (just completed) of securing greater access--a process that is actually in Act I.

The road-map to the solution of the quality/cost conundrum exists and has existed for some time--but, it has been ignored. The Dartmouth Atlas publishes a yearly study of the variation in use of various medical procedures across the geographical USA. It not only demonstrates a wide variation in the use of invasive procedure to treat common conditions but surprisingly shows that the MORE health care you receive, the WORSE becomes your outcome. In short, the overuse of aggressive high tech medical care can be toxic to your health. Florida, New York, New Jersey and Los Angeles top the list (surprise, surprise).

Correcting this overuse of marginally beneficial medical procedures will take a seismic shift in medical policy. Special interest groups are already digging in their heels. However, we may be approaching a tipping point. Fortune magazine, usually considered a conservative source, published an article last November that outlined the overuse of five common procedures. It recommended that if your doctor has ordered up one of them, to either get a second opinion or run for the hills. Reports concerning excessive radiation exposure from the overuse of CT scans are reaching the lay press. In short, the overuse of medical procedures, medications and therapies are becoming part of the public's consciousness. New diseases (mostly mental) are cropping up faster than we can categorize them. How many of them are real as opposed to just personality quirks?

Correcting this medicalization of everything will be difficult. Key to any frontal assault on the quality/cost issue will be a fundamental overhaul in how statistics are used (misused) to justify the care that we receive. This misuse and misunderstanding of statistical methods has been a dirty little secret of organized science for some time. Yet, the misuse of statistics has made many a career, propelled many a promotion, generated a lot of sales and made a lot of people rich. Forcing a proper use of statistics will be a sea-change that will be difficult to construct.

Let's give our hard working leaders a month to gloat over their shallow victory. Then, we must demand that they attack the other 2/3's of the problem--cost and quality. That is the Heavy Lifting. As health care costs approach 20% of GDP, we had better get it under control before it tanks the entire economy.