Political Nostrums About Controlling Health Care Costs: A Case Study

Oh, those wacky politicians. Blessed with a charismatic ability to spin half-truths into yummy sound-bites, the more successful ones float into our field of view like oversized blimps and mesmerize us mere mortals with astonishing chutzpah and plausible fibbery.

Look no further than the Health Affairs blog for an example of this kind of spectacle, courtesy of none other than the Keystone State's Governor Edward Rendell. His approval ratings are lower than Obama low, budget crisis impasses are routine, taxes and spending are out of control and he still has time to share his half-baked health policy opinions. They make for an, ahem, interesting read.

It's easy, says the Disease Management Care Blog's Governor, to reduce health care costs. It's just a matter of....

"...not paying for medical errors (1); decreasing the number of hospital-acquired infections by requiring hospitals to report the rate of such infections and penalizing hospitals that do not make progress in limiting them (2); fostering the development of “medical homes” in practices across the state (3); and expanding the scope of practice of nonphysician medical providers (4), thus promoting the growth of after-hours clinics staffed by nurse practitioners and other providers and thereby cutting the number of unnecessary emergency department visits by people unable to access their physicians on nights and weekends (5)."

1. What Mr. Rendell is probably referring to is the adoption of Medicare's 'no pay' policy for hospital acquired conditions (HACs). While many HACs are avoidable, their overall frequency is much lower than the salacious media would have us believe. In this Health Affairs study, the future economic impact of the policy is estimated to be negligible.

2. Check out this study report looking at the statistics behind dreaded "Staph" infections among patients discharged nationwide: 0.8% of patients.

3. Oh? Other than a few studies in Medicaid or integrated delivery system settings, the DMCB can find no conclusive evidence that the medical home reduces costs in community care settings. Isn't the fact that this is all still rather experimental why they're calling them "pilots?"

4. Mr. Rendell may have special biases about the role of non-physicians as primary care providers thanks to his spouse, but this isn't a slam dunk solution thanks to a similar shortage of nurse practitioners as well as lingering economic dysfunctions.

5. That's a commonly held perception, but this review of the literature fails to support the contention that uninsured persons using the ER do so for lack of primary care access or for the sake of convenience. While primary care access undoubtedly plays a role in patients' willingness to use an ER, that's still less than 3% of the nation's health care bill.

It'll take more than these overused platitudes to control health care costs. The DMCB ultimately admires Mr. Rendell and knows he's a lot smarter than this. Pennsylvanians and readers of the Health Affairs blog deserve better.

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