This editorial will appear in Friday’s print edition.
The fundamental dilemma of health care reform isn’t whether to adopt a public plan or extend coverage to the uninsured – important as those discussions are.
The core problem is how to stop squandering so much money on needless treatment that doesn’t help patients. If the dollars followed results instead of procedures and visits, there’d be better results and fewer wasted – and costly – procedures and visits.
If the waste were pared out of the system, it would be far easier to cover the uninsured, run a cost-effective public plan, help companies maintain coverage for their employees, offer affordable premiums to individuals, etc., etc. It all hinges on costs.
U.S. Sen. Maria Cantwell of Washington gets this. This week, she succeeded in amending a key reform care bill in a way that would reward quality of care instead of quantity of care.
The amendment affects only Medicare, but that’s a very big “only.” Medicare lies at the heart of the heart of the problem. It has always operated on a fee-for-service basis: The doctor or hospital submits the bill, Medicare writes the check. More bills, more checks.
Medicare is going broke on this model. Historically, the program has fueled the hyperinflation that has made health insurance such a scarce commodity in this country.
There’s a further perversion in the way it operates. Because its reimbursements are based on historic expenses in different states, states with a tradition of cost-effective care see smaller reimbursements than states with a tradition of excessive spending. As a result, Washington doctors and hospitals get penalized for their virtue; high-expense states like Florida get rewarded for their vice.
Cantwell’s amendment would direct the Health and Human Services Department to reward quality instead of quantity by emphasizing integrated, coordinated, patient-focused treatment. There are many ways to hold down medical costs; this is an important one.
Coordinated treatment is delivered in a health care organization that knits together primary care doctors with specialists. For the patient, it’s one-stop shopping. Every doctor knows what the other doctors are doing. Patients are not constantly asked the same questions. Medicare records are not duplicated. Prescriptions don’t conflict.
Examples include Washington’s Group Health and The Everett Clinic, Minnesota’s Health Partners and Mayo Clinic, The Cleveland Clinic of Ohio. None of these organizations is perfect, but as a group they tend to perform well while avoiding needless expense.
Pushing Medicare in this direction – and away from fee-for-service – is an especially promising way to rein in the waste that has helped make universal health coverage such a devilish problem in the United States.