Archive for October, 2009

Wringing the Health Care Sponge

The following does not necessarily reflect the views or opinions of my employer…but then again maybe it does…you should probably check with them.

This will be a very short post for me. It’s more a question for discussion than a startling revelation. I hope that those of you who read this will share your thoughts on the subject. It seems that the discussion of health care (a.k.a. insurance) reform seems to have found some common ground, at least in a few areas. We seem to agree that the primary care infrastructure of our country needs to be rebuilt. We also have reached some degree of consensus with regard to the issue of the primary care work force. Essentially, we don’t have enough primary care physicians to meet the current need, much less the need that will be generated once we provide insurance to the majority of the currently uninsured in the USA, and the only way to improve that reality is to make the primary care practice environment more attractive to potential physicians and other clinicians. That, unfortunately, but realistically, means money. The conventional wisdom is that we will find that money – the money needed to improve payment for primary care – in the efficiencies we will create. In simple terms, we’ll cut out the waste in the system and reinvest part of the savings in the system.

Let’s pretend for a minute that we believe that we can come to consensus on how to find those savings. Let’s imagine that we live in a world where everyone with an interest in status-quo will give up the fight for the betterment of humanity. Let’s assume that we really can find the inefficiencies (probable), enforce policies that reduce those inefficiencies (less probable), and actually realize savings in the system by becoming more efficient (questionable at best). Now let’s imagine that next year, we are able to redirect a sum of money back into the system as a result of our success in controlling waste. What then? Does anyone believe that this year’s ceiling does NOT become next year’s floor?

Let’s play just one more “what if” game. What if the inefficiencies and waste in the system are so great that we will be able to ride the wave of savings for 5 or even 10 years in blissful ignorance of the coming judgment day when there are no more savings to leverage? Is it possible that the people making the decisions have actually seen a sponge and realize that regardless of how saturated it may be there is a point where you’ve wrung all the water out, and no matter how much you twist, it’s still a dry sponge? Is it cynical to think that we are allowing politicians to do what they always do…put off the truly difficult decisions, the ones that require true leadership and the risk that comes with it in favor of a fix that will last long enough that they can turf the problem off to those who follow?

Basing our ability to fund health reform on cost-savings alone will only put off the inevitable reality that we will someday face; that we cannot simply work the expense side of the healthcare ledger and expect that our methods will be sustainable. That means we either generate more revenue (can you say “taxes”), maybe not today, but certainly at some point in the future, or we restrict access and services. Neither of those choices are particularly palatable for most Americans, but they will be no more palatable 5 or 10 years from today. They will, however, be far more urgent.

This is just one man’s opinion. I’d love to hear yours.



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