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Health-care leaders have ideas for how to fix nation's system
Results we get now are not worth money spent
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Starbucks found that relatively inexpensive physical therapy worked to help its employees' back problems, avoiding expensive MRIs.
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Published: November 30, 2008
WASHINGTON
Talk to the chief executives of America's pre-eminent health-care institutions, and you might be surprised by what you hear: When it comes to medical care, the United States isn't getting its money's worth. Not even close.
"We're not getting what we pay for," says Denis Cortese, the president and chief executive of the Mayo Clinic. "It's just that simple."
"Our health-care system is fraught with waste," said Gary Kaplan, the chairman of Seattle's cutting-edge Virginia Mason Medical Center. As much as half of the $2.3 trillion spent today does nothing to improve health, he said.
Not only is American health care inefficient and wasteful, says George Halvorson, the chief executive of Kaiser Permanente, much of it is dangerous.
Those harsh assessments illustrate the enormousness of the challenge that awaits President-elect Obama, who campaigned on the promise to trim the average American family's health-care bill by $2,500 a year. Delivering on that pledge will not be easy, particularly at a time when the economic picture continues to get worse.
Sen. Max Baucus, D-Mont., the chairman of the Finance Committee, has already warned that improving and expanding health care will cost money in the short run -- money that his Republican counterpart, Sen. Charles E. Grassley of Iowa, argues the government does not have.
Yet among physicians, insurers, academics and corporate executives, there is remarkably broad consensus on what ought to be done.
A high-performance 21st-century health system, they say, must revolve around the central goal of paying for results. That will entail managing chronic illnesses better, adopting electronic medical records, coordinating care, researching what treatments work best, realigning financial incentives to reward success, encouraging prevention strategies and, most daunting but perhaps most important, saying no to expensive, unproven therapies.
"There is more than enough money in the system," said former House speaker Newt Gingrich, who runs the Center for Health Transformation. "We just are not spending it well."
The United States today devotes 16 percent of its gross domestic product to medical care, more per capita than any other nation in the world. Yet numerous measures indicate that the country lags in overall health: It ranks 29th in infant mortality, 48th in life expectancy and 19th out of 19 industrialized nations in preventable deaths.
One way to reconfigure health spending is to shift large sums into prevention and wellness, said Reed Tuckson, a physician and executive vice president at UnitedHealth Group in Minneapolis. The idea is to tackle the handful of preventable, chronic illnesses such as heart disease and diabetes that account for 75 percent of health-care costs.
Since Obama's victory, official Washington has been racing to demonstrate its seriousness about expanding health coverage to every American, while at the same time improving the quality of care. But few of the politicians talk about the difficult trade-offs that will come with any real reform.
One fundamental problem is how doctors are paid, Kaplan said. Under the current fee-for-service scheme, "the more you do, the more you make," Kaplan said. There is no incentive to keep people out of doctors' offices, hospitals or clinics.
It is possible to change the incentives, Kaplan said.
Helen Darling is president of the National Business Group on Health, which represents large employers. The members of Darling's group are in the vanguard of a movement toward comparative effectiveness research, which evaluates various drugs, devices and treatments and publicizes which work best and at what cost.
Ideally, doctors and patients armed with that data could make more rational decisions -- such as whether to choose a more expensive, but therapeutically equivalent, medication.
Former Sen. Thomas A. Daschle, Obama's choice to head the Department of Health and Human Services, endorsed the use of comparative effectiveness data in a book he co-wrote.
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