Over the last three years, America has published a number of insightful articles on the U.S. health care system, including “Healing Health Care” by Guy Clifton, “Then There Was One” by Daniel Sulmasy, “The Financing of Health Care” and “The True Cost of Care” by Uwe E. Reinhardt, “Diagnosing U.S. Health Care” by Mary Jane England, “A Struggle for the Soul of Medicine” by Myles N. Sheehan and “Curbing Medical Costs” by Daniel Callahan. Callahan, an ethicist at the Hastings Center, a nonpartisan bioethics research institution in New York with a keen interest in public policy, has worked on this issue for decades and his voice is important, even if his latest message is sobering. In a just published article in The New England Journal of Medicine, “Cost Control—Time to Get Serious,” Callahan argues that cost control is still not being taken seriously enough, despite the current push in Congress to draft reform legislation. Here are a few highlights.
"Although everyone bewails rising costs, the constituency for doing something about them is skimpy," writes Callahan. Real reform is caught on the horns of a dilemma: "cost controls that are likely to be politically acceptable will not be very effective, and what might be effective will not be acceptable." Reform requires a genuine resolution of the dilemma, he thinks. But how is that possible, when politics is the vehicle we have, and political acceptability is the key to both getting votes and passing laws?
Answer: it won’t be easy, but we should still try. Callahan looks at several of the proposals for reducing costs like one that aims to reduce costs across the board to a 3 percent growth (G.D.P.) each year. That is half the current level of annual increase. Such a reduction would require enormous changes, he writes, “changes in medical and professional values, patients’ demands and expectations, industry profit seeking, research aims and aspirations, and the culture of American medicine, much of which has been dedicated to unlimited progress and technological innovation, cost be damned.”
If that makes you feel hopeless, it needn’t. Callahan himself finds hope in some of the more significant items on a list of more than 100 cost-control possibilities compiled by the Congressional Budget Office, many of which concern Medicare. Two examples are freezing the rates for physician reimbursements for Medicare and increasing particular premiums for Medicare services.
But the gist of Callahan’s analysis is that too many leaders and ordinary Americans are still not ready to impose limits on procedures, services or payments. They—we all--want too much. Callahan cites a recent opinion poll to back up his view. What is needed, he insists, are significant limits, real curbs in many different areas including public expectations, before real reform can take place.
Callahan also edits an online newsletter called, The Healthcare Cost Monitor, for those who would like to keep up with the subject.
Karen Sue Smith