Friday, December 14, 2012

How To Solve Most of our Budget Problems and Improve Our Medical Care

Over the last 10 years, average wages in the United States have increased 38%, while the cost of health care has risen 131%. If other costs during my lifetime increased at the same rate, a dozen eggs would now cost $38, and a gallon of milk would be $48. Why this difference? What can we do about it? What should we do about it? That is what we should be talking about every day.

To listen to the superficial analysis of our politicians and talking heads on TV, we face a stark choice: we must either go bankrupt as a nation, or cut back on the benefits of programs like Social Security and Medicare that people have paid into for years. Are these really our only two choices?

The answer is, we do have a better way! As a family physician with over 35 years of experience, I can testify to that fact that I see copious waste in our medical care system occur every day. Every doctor can tell you the same thing, and many others have documented this waste as well. In fact, the Institute of Medicine has published information that reveals a total of $765 Billion dollars of waste in 2009. If we can solve this problem, our budget concerns go away.

So, where is this waste, exactly? Well, $190 Billion comes from wasteful administration - all of the forms and complex rules we deal with every day, that are different from plan to plan. $130 Billion comes from poor efficiency - the lack of coordination that results in tests being repeated, and one part of our system not talking well with the other. Unnecessary care cost $210 Billion dollars in 2009. These are the tests you didn't need, and the care that didn't really address what would solve the problem. Missed opportunities to prevent illness cost an additional $55 Billion dollars - flu shots,  immunizations and good primary care that was never given. Fraud was also a factor, accounting for $75 Billion in waste. Criminals need to be prosecuted and locked up.

What would a different system look like? To me, the answer is simple. It would be a system built around the actual needs of patients, that gives every person a primary care medical home to provide most of their care, and coordinate with other care givers when they are needed. Payments would be partially based on the quality of care outcomes and satisfaction of those we serve. 

If we make this choice, we will not only solve our budget problem, we will also lay the foundation for a healthy and productive population for years to come. Let's have that discussion!