Back to Work - Bill Clinton [29]
You can see the problem. Medicare, Medicaid, and the Children’s Health Insurance Program cost the taxpayers a lot of money and will add to our budget woes over the next decade. On the other hand, they cost less than the same services would if their beneficiaries were covered by private insurance. So privatization would either lead to more overall health spending or less coverage and its consequences.
That is why the voucher plan passed by the House of Representatives is such a bad idea. It will force seniors into a more expensive market, with more rapidly rising prices, requiring many of them to lower their standard of living or forgo needed health care.
The Simpson-Bowles Commission took a different approach, recommending a number of cost-cutting measures and much more modest cost shifting to beneficiaries, setting a budget cap for total health spending, and urging a dramatic acceleration in implementing reforms that would both save money and improve the quality of care.
Before you roll your eyes and say that’s not possible, consider these examples. First, remember the one I cited earlier of the tens of billions of dollars hospital-acquired infections add to health-care costs every year, and the very inexpensive sterilization practices that will prevent the vast majority of them if all hospitals do what the VA system has already begun to do. Second, the Geisinger medical group in northeastern Pennsylvania, with more than seven hundred doctors, promises people who enroll that if someone hospitalized under its care has to return to the hospital within ninety days of release, the group will bear the entire cost of care, with no effect on the insured’s premiums or related costs. The group made the guarantee after all the doctors agreed to follow the latest “best practices” in treating every condition. The best practices are provided to all the group’s doctors in a continuously updated manual. Since adoption of the best-practices model, medical errors, hospital readmissions, and costs have dropped dramatically.
Third, the Mayo Clinic pioneered a system now being adopted by other providers. To further reduce the incentives to increase revenue with unnecessary procedures, all the doctors are on salary. Therefore their incomes are unaffected by how many tests they run. As everyone knows, the quality of Mayo Clinic health care is high. But not everyone knows that the Mayo system keeps costs lower than many other providers.
Still not convinced we can save money and improve health care? Every year Pennsylvania requires hospitals to report what they charge for various services and what the results are. So far, this information has shown that there is a dramatic difference in the costs of the same procedure from hospital to hospital and no connection between the higher costs and better results. The health-care reform law requires the release of statistical information by hospitals and doctors nationwide on Medicare patients. This provision, originally supported by then senator Judd Gregg, Republican of New Hampshire, and Hillary, when she was a senator from New York, would allow the analysis of hospitals’ and doctors’ decisions and performance in a way that protects patient privacy but has the potential to save a lot of money and improve care. According to the Dartmouth Atlas of Health Care, more than 40 percent of Americans don’t receive the best available care, and the care they do get is often needlessly expensive.
One of the most important recommendations of the Simpson-Bowles Commission is that the secretary of health and human services, Kathleen Sebelius, expedite testing and evaluation of promising reforms that lower costs and improve quality and use the leverage of Medicare and Medicaid payments to get them