Calculating the costs and benefits of health care reform
The health care debate heating up in Washington makes most people really nervous, and rightfully so. At this point, the plan is complicated and the benefits have not been clearly conveyed, which is one reason Americans seem to be less pleased with the way President Obama is handling the issue, judging by recent polls.
During last night's prime time news conference, the president made a convincing argument for spending a trillion dollars on health care reform in the midst of a severe recession, after already committing to an enormous economic stimulus package. He explained how health care reform is crucial to his plan to rejuvenate the economy, and he made it clear that "health insurance reform will not add to the deficit." While that's reassuring, many people will likely remain wary until they learn how the plan relates to their own lives.
What's still alarming to some are claims that the proposed legislation may not be able to both increase coverage to an additional 46 million Americans without insurance and also reduce the costs of insurance. In fact, the director of the Congressional Budget Office (CBO) said last week that none of the health care bills under consideration would significantly curtail health care spending. But by its own admission, the CBO can't take into account many of the savings that will likely result from the new legislation.
For example, President Obama and the Democrats in Congress have not outlined how much taxpayer money has already been spent providing care to the 46 million uninsured and many more under-insured. Providing adequate health care services, including preventive care, to this group, would represent a huge savings.
Once we get over the sticker shock and realize that overhauling a broken system is going to take some up-front money, health care reform can pay for itself in the end. I realize that the president wants to pass legislation before the August recess, but lawmakers need to make sure they get it right, regardless of how long it takes.
In order to slow the growth of health spending over the long haul, the final plan must include a mechanism to encourage preventive, cost-effective, evidence-based care. It also needs to provide incentives to doctors who work to prevent chronic diseases (as opposed to rewarding them for over-testing and over-treating patients). Last night the president mentioned the need to replicate models of care like the Mayo Clinic and Cleveland Clinic, where figuring out reimbursements take a backseat to patient care. That is a good start.
When I first went into private practice a decade ago, I sometimes offended pregnant women when I counseled them about gaining too much weight in pregnancy. I know it's a touchy subject, but I didn't realize that many doctors don't bring it up because they don't want to give patients reasons to leave the practice.
I often tell the story of a patient who gained 100 pounds during her pregnancy. When I asked her about her diet she said she eats hot dogs every day. I spoke with her about making better choices, but she insisted that she "loved hot dogs." I've obviously never had the cravings of pregnancy, but I assured her that nobody likes hot dogs more than I do. I advised her that hot dogs need to be a rare treat, not a staple of her diet.
Pregnant women who gain upwards of 50 pounds face greater risks of gestational diabetes, delivery by Cesarean-section and other complications, all of which cost much more than an uncomplicated traditional delivery. Every day, doctors treat patients with dozens of costly ailments or diseases that can result from poor lifestyle choices. Management of chronic disease in America accounts for 75 percent of all health care costs.
If we can stop or reverse this trend, we'll have a healthier population, and it will contain costs, although we may not see some of the savings for years, perhaps decades. Can you really put a price tag on that?
Russell Turk, M.D., is an obstetrician and gynecologist in Fairfield County, Connecticut.