Wednesday, July 23, 2008
Potential voters in November are starting to pay more attention to what the leading presidential candidates have to say about how to reform our health care system. In a new article from the New York Times magazine, David Cutler responds to the principles underlying Senator Barack Obama's proposals. Cutler basically says that the US should focus on improving the quality of care rather than on reducing our consumption of it. Rather than pay less, they want to pay more wisely, and encourage health-care providers to do more of what they should and less of what is wasteful by building proper incentives into the system. Chief among these ideas is to support the personal medical home, which we have been writing about in this blog, and to continue the role of our private health care insurers, but with oversight and regulation that promotes these aims. In my opinion, this is the right direction, and voters have a clear choice in November.
Thursday, July 17, 2008
Alas! The Commonwealth Fund Commission on a High Performance Health System released its first health system scorecard two years ago, and found that the United States fell far short of benchmarks for access, quality, efficiency, and other key measures of health system performance. Now, two years have gone by, and the 2008 edition of the scorecard paints an even bleaker picture. Instead of organizing around change for improvement, supporting the ability of primary care to provide a personal medical home and holding insurance companies accountable to help improve care, congress has gone through their annual dithering about how much to lower doctor rates, insurance plans have continued to cherry pick low risk subscribers, and the number of primary care doctors has continued to dwindle. It is no surprise that we have gone from bad to worse! Our system is perfectly designed to get these results.
The United States scored an average of 65 out of a possible 100 across 37 indicators— below the overall score in the 2006 report, which was already abysmal! The U.S. health system is on the road to a train wreck. Of greatest concern, access to health care has significantly declined. As of 2007, more than 75 million adults—42 percent of all adults ages 19 to 64—were either uninsured during the year or poorly insured, up from 35 percent in 2003. At the same time, the U.S. did not keep pace with gains in health outcomes achieved by the leading countries. The U.S. now ranks last out of 19 countries on a measure of mortality amenable to medical care, falling from 15th as other countries raised the bar on performance. Up to 101,000 fewer people would die prematurely if the U.S. could achieve leading, benchmark country rates.
The U.S. spends twice per person what other major industrialized countries spend on health care, and our costs continue to rise faster than income, while our quality results continue to plummet. We will soon have $1 of every $5 of national income going toward health care. We should expect a better return on this investment. We should be outraged.