Friday, May 31, 2013

The U.S. Health Care Debate in Five Bullet Points

"This message will self-destruct...."
The international arm of the Disease Management Care Blog is working on a presentation for the upcoming Hauptstadtkongreß in Berlin Germany.  Its "Mission Impossible" is to explain the U.S. health care system to a group of German hospital executives in a half hour.

This, in a Nußschale, is what the DMCB intends to say, using approximately eighteen PowerPoint slides:

1. While rising health care costs, as a percentage of U.S. GDP, has always been a problem, rising health care costs as a percentage of U.S. debt is widely viewed as a highly significant threat. We mean it this time.

2. The conservative vs. liberal debate over how to reduce health care costs for the U.S. government is ultimately about transferring its insurance risk.  The conservatives want to transfer risk to patients in the form of vouchers, while the liberals want to transfer risk to providers in the form of bundled payments and gain-sharing.  The liberals, so far, are handily winning the debate.

3. Risk is only half the health reform story.  The other half is quality. There is bipartisan consensus that a) U.S. health care quality could be better, and b) greater quality will mitigate insurance risk, resulting in fewer medical complications, emergency room visits and readmissions.
4. There is additional bipartisan consensus that a) insurance risk can be managed and b) quality can be increased when care is provided in large vertically integrated and regional provider systems.

5. If the twin exigencies of risk and quality are not addressed in the next 3-5 years, disappointment could lead to the unraveling of Obamacare and the introduction of a public payer option.

Image from Wikipedia


Johnathon Ross MD MPH said...

Why is there no mention of the financial complexity of the American health system and it's associated high administrative costs? The added costs of the insurance and billing overhead in the US adds at least 10% to our total health care spending. We have an army of bureaucrats chasing the money around our insanely opaque and complex health care financing system. Multiple studies by the US government and private econometric experts suggest that we could cover all the uninsured and improve coverage for all Americans with the simplicity of an improved and expanded Medicare for all.

Jaan Sidorov said...

Good observation. In my defense, my first point was that costs (which are driving debt) are unacceptably high. I didn't go into what's responsible for the costs, including your insight that admin overhead is a big part of the problem.

That being said, conservative market-minded pundits point out that Medicare a) has low admin overhead because all it has to do is issue regulations that transfer admin costs to providers and b) much of the arcane market distortions is due to Medicare's meddling.