What is the single most important thing we can do to reduce health care cost?
Well, we can ration care, by setting age limits for expensive procedures, but this is hardly fair and compassionate. We can make particularly high co-pays for certain very expensive, cutting age procedures (like multiple organ transplants), but again, anything that favors the wealthy can and will be viewed as unfair by the current powers that be. (Incidentally, to come up with a system where wealthy people DON’T have all the advantage is impossible). We can force drug companies to reduce costs, or ask for comparative studies (a $1.1 billion provision for “comparative effectiveness research” was at some point in the stimulus package—not sure if it made it to final version to be signed this week) but this may force the drug companies to invest entirely in the more risky, innovative drugs. Incidentally, it is not often that easy to figure out whether drug A is better than drug B—in cases where the differences are relatively small, very large studies need to be conducted, and then who is going to decide if the slightly better safety profile of drug A outweighs the better efficacy of drug B. It can be done, but it’s not easy and it doesn’t always lead to a definitive conclusion.
One thing that can be done right away is to institute prevention clinics and programs. There is no doubt that many chronic diseases are practically self-inflicted, and behavior modification is sometimes all it takes to delay their onset. Prevention can be done either on the individual level or population-based. Both involve relatively simple instructions, for example:
Eat less; eat less fat; eat less salt; eat healthy foods like vegetables, fish, nuts, fruits (like berries); avoid hydrogenated fats; avoid saturated fats (fatty meats, certain pastry). So the health professional can deliver these (and other) advices either one-on-one, or to groups of individuals (like schools) or to large segments of the populations via mass media. The President and the surgeon general can be very effective advocates and voices for this approach—just by talking about it from their bully pulpit. (Assuming the President will have stopped smoking by then…).
There are many reasons why this information has been slow to trickle down to everyone, and certainly it is slow to be implemented. Deeply ingrained cultural culinary habits and the huge industries anchoring them, plus the higher cost of many healthy foods won’t be easy to overcome, but if prevention becomes the buzz word for good health it will be embraced fully.
I know that many people resent this kind of interference by a “nanny” state, claiming that it’s nobody’s business what a person does for her health. This would be true if the insurance status of the population were not so intertwined. In any event the solution is simple: people who attend prevention clinics and follow those sensible guidelines will get a lower insurance rate. Also, prevention clinics will need to be subsidized (by government, who else) initially to guarantee their sustainability.
Finally, healthier foods need to be made more affordable to everybody, and again, in the context of the current stimulus plan could be done by government. I’m against intrusive government programs, but by establishing a prevention culture (and thousands of prevention centers run by private entrepreneurs) we will get the most bang for our healthcare buck.
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Local public health departments and various non-profits have been filling this role for years. Unfortunately they only receive about 5% of the proverbial health care dollar.
Our healthcare system is really a “sickness” care system where we do nearly nothing until we’re sick. Medical education has been built around treating illness and not around maintaining health. Furthermore, reimbursement reinforces this. We pay little or nothing for preventative care. Our current leadership can take on initiatives as Kennedy did with Vim and Vigor that sought to change how our culture views wellness and our role in maintaining it.