Wanted: Restraint on Health Care

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 (www.thehastingscenter.org/HealthCareCostMonitor/Default.aspx).

"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?

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 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

Comments are automatically closed two weeks after an article's initial publication. See our comments policy for more.
8 years 2 months ago
You know, changing health care really might still be a hopeless task.  A small group that tried to analyze the system and determine how it could actually be changed for the better concluded that it was a hopeless task - in 1985. Then health care cost half of what it does now as percentage of the national economy. Except for dreamers who can imagine a better system, there is, it seems, just no motivation for any of the major players to really call for a change that will actually be a change.
8 years 2 months ago
Thanks for this helpful archive of articles on healthcare reform.  The best way to fight the political inertia you describe is to continue raising awareness and urgency with our representatives, particularly in their August constituency meetings.  Representatives need to hear people advocate for options like the ones in these articles.  They need to hear support for the Wyden-Bennett approach to funding healthcare, the sensible and sensitive end-of-life protocol developed at the Mayo Clinic, and support for malpractice reform that protects patients while scaling back the incentives for belt-and-suspenders care that causes costs to mushroom. Finally, let your representatives know that you support the bipartisan dialogue in the Senate Finance Committee.  Voters with Republican representatives should let them know that opposition without alternatives is unacceptable.  Now is the time to reform the system and provide coverage opportunities for everyone.  Let's not let another 16 years pass before someone takes a serious stab at comprehensive national reform.

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