Prevention is the #1 Health Care Cost Containment Myth; Rationing is the True Pathway
Scientists from all over the world came together earlier this month and in one powerful voice told us that we human beings broke our planet. They urged us to stop questioning the existence of global warming and to begin implementing known and proven strategies to mitigate the problems that a 4-to-5 point rise in worldwide climate temperatures in the near-term will cause. Hopefully, world leaders will listen and begin to do the real work needed to sustain life on earth.
We need a similar reality check with regard to reforming our health care delivery system in California and the U.S. Our system neither provides for the efficient access to health care that 6.5 million uninsured Californians or 47 million uninsured Americans need, nor is it able to sustain the twice-to-thrice annual health care cost growth to overall inflation ratio that will soon cripple our ability to do much about improving access for anybody.
The unbridled inflation in health care costs might, in fact, cause the uninsured population to grow even more, as American businesses cut back or abandon their support of our employer-financed health care delivery system. As a result, academics, policy wonks and politicians alike agree that constraining the growth in the cost of health care is critically needed. However, many of them misguidedly point to health promotion, risk reduction and personal health prevention strategies as keys, if not silver bullets, for curing health care cost inflation. We need to stop propagating this myth and begin dealing with the truth. We need to face the reality that rationing, not prevention, provides the better pathway to achieving real and measurable health care cost containment.
The sad fact is that health care costs rise as a result of increased consumer demand and resource consumption, caused by advances in medical technology and pharmacology, improvements in medical treatment regimens, and the aging and expansion of our population. Keeping people healthy for longer periods of time contributes mightily to individual quality of life and workplace productivity, but it does little to contain the overall cost of health care because all who do not die as a result of an unexpected life-ending event will encounter the health care delivery system at an age when the cost of medical care is the most extreme.
As reported in Scientific American , “Even if we were to be successful with the prevention of all diseases,” notes Faith T. Fitzgerald of the University of California at Davis, “we would bear a population of older people undergoing biological decay, who could live longer and cost more while they were dying.” Accordingly, we need to tame our insatiable appetites for access to any and all medical treatment regimens and devices available regardless of cost relative to benefit.
As Bill Plested, president of the American Medical Association said recently, we all know someone who has either prosthetic body parts, stents in their veins or had their cataracts removed. If we consumers are unable to reign in our thirst for low-benefit medical treatment, then policies must be designed to govern and restrain our costly quests for extending our lives for a few extra weeks, months or even years. A ban on advertising prescription drugs to consumers would be a good place to start. Science-based access to medical care and rationing are as important elements to real health care finance and delivery system reform as is universal coverage and access.
Not only may we not look to prevention as a cure to rising health care costs, we need to really examine each prevention strategy to determine if it contributes to the rise in costs. In fact, the federal Office of Technology Assessment (OTA) reports that of all the preventive services they evaluated, only three paid for themselves in the end: prenatal care for poor women, tests in newborns for some congenital disorders (such as phenylketonuria and hypothyroidism), and most childhood immunizations. While most everything else we do to improve our health status contributes to a better quality of life and productivity, these strategies cannot be counted upon as levers of health care cost containment over time.
And while we are talking about myths and reality checks, should we really give priority to extending coverage to uninsured kids, which seems to be the rave right now in our country? This may be a popular stance for politicians to take, but it’s the uninsured adult population that is breaking the bank! Anyway, I digress. Let’s save that discussion for a future blog.