As we get closer to the presidential election, the candidates will share greater details of their national health care proposals. Depending on individual political views, people can argue the merits of both positions.
Briefly, as described by Health Affairs, a policy journal, Sen. Obama’s health care proposal focuses on expanding insurance coverage and provides new subsidies to individuals, small businesses, and businesses experiencing catastrophic expenses. The analysis reports that the plan greatly increases the federal regulation of private insurance and creates questions about fiscal sustainability. (His plan includes a National Health Insurance Exchange, much like the Commonwealth Health Connector like we have in Massachusetts.)
Health Affairs explains that Sen. McCain’s health plan makes employer provided health benefits taxable as income for employees and in return, gives each employee a refundable tax credit-- $2500/individual and $5000/family--for those who purchase coverage. The analysis predicts increased costs to employees, reduced benefits and fewer consumer protections.
Both proposals seek to reduce administrative and medical costs in a variety of ways, but they also offer insight into a larger philosophical perspective on the role of government in the marketplace. Independent of the presidential race, however, there are opportunities today for those of us in the health care community to identify cost savings. A common, though no less staggering, statistic estimates that 30 percent of annual health care spending is unnecessary, which adds up to $600 billion annually.
(There are some studies that are not so conservative and say that the figure is closer to $800 billion in unneeded services.) Either way this is money that we can ill afford to waste.
In my past blogging I have written about the necessary societal shift to prevention and wellness to improve health and reduce health care costs, but that shift doesn’t happen in a vacuum. There are other, related actions that improve quality, reduce or eliminate unneeded services and save money.
According to a study released earlier this year by the New England Healthcare Institute titled, "Waste and Inefficiency in the U.S. Health Care System,” there are numerous opportunities for dramatic costs saving in today’s health care system by eliminating waste, which was defined as health care spending that can be eliminated without reducing the quality of care.
In general, none of the findings were surprising. For example, the overuse of non-urgent emergency care and the overuse of antibiotics for respiratory infections are practices that are well known. But the area that has the most opportunity for improving quality and reducing costs is reducing variation in intensity of medical and surgical services, which can be done by using evidence-based data to identify best practices. In other words, ensuring that the right care is being delivered at the right time and in the right setting.
At Tufts Health Plan, our medical directors and clinical staff work closely with our providers to implement evidence-based programs. Our own experience has shown improvements in outcomes and in cost savings that we have been able to pass on to our customers. Finally, our experience has reinforced my belief that together with wellness and prevention, evidence-based medicine is an effective tool that should be more broadly adopted—no matter who becomes president.
James Roosevelt, Jr.
President and CEO, Tufts Health Plan
This program aired on September 30, 2008. The audio for this program is not available.