The first debate between President Obama and Governor Romney had both of them agreeing on an aspect of health care that has not really received enough attention. Both of them used as examples the Cleveland Clinic and Mayo Clinic models of delivering health care for providing high quality at reasonable cost.
However, neither of them emphasized that the reason costs are controlled in this model is because physicians are not paid on a fee for service basis. The doctors receive salaries and have no incentives to perform extra tests or procedures to enhance their incomes. As the Institute of Medicine recently reported, 30% of care given to patients is unnecessary. This was previously reported by the Congressional Budget Office and investigators at Dartmouth Medical School. In other words, about $900 billion of the $2.7 trillion spent on health care in the U.S. goes for extraneous care.
The market is inefficient as far as health care is concerned because of the disparity in knowledge between physician and patient. If a doctor says a test or procedure is necessary, the patient usually agrees. And patients don’t search for the cheapest doctor to treat their cancer or heart disease. They want the best, though they often go for the most convenient.
Fee-for-service payment for physicians is the market-based method of paying for health care and it clearly does not work as our escalating health care costs show. Both presidential candidates appear to agree that better health care at lower cost can be provided by the Cleveland and Mayo Clinic models. So why can’t the Republicans and Democrats get together and change our system of health care delivery to simulate a system that both presidential candidates agree works better?
Defensive medicine also plays a role in driving unnecessary care as physicians try to protect themselves against malpractice suits. Thus, serious malpractice reform must also be enacted as part of health care reform.
The bottom line is that the market is inefficient in terms of controlling health care costs and another model is available that appears to work well. Let’s try to get both parties together to change the health care system to control costs and deliver quality care by a proven method. The money saved can be used to lower the budget deficits and rescue the Medicare and Medicaid programs.
Resurrecting Democracy
em>A VietNam vet and a Columbia history major who became a medical doctor, Bob Levine has watched the evolution of American politics over the past 40 years with increasing alarm. He knows he’s not alone. Partisan grid-lock, massive cash contributions and even more massive expenditures on lobbyists have undermined real democracy, and there is more than just a whiff of corruption emanating from Washington. If the nation is to overcome lockstep partisanship, restore growth to the economy and bring its debt under control, Levine argues that it will require a strong centrist third party to bring about the necessary reforms. Levine’s previous book, Shock Therapy For the American Health Care System took a realist approach to health care from a physician’s informed point of view; Resurrecting Democracy takes a similar pragmatic approach, putting aside ideology and taking a hard look at facts on the ground. In his latest book, Levine shines a light that cuts through the miasma of party propaganda and reactionary thinking, and reveals a new path for American politics. This post is cross posted from his blog.
Political junkie, Vietnam vet, neurologist- three books on aging and dementia. Book on health care reform in 2009- Shock Therapy for the American Health Care System. Book on the need for a centrist third party- Resurrecting Democracy- A Citizen’s Call for a Centrist Third Party published in 2011. Aging Wisely, published in August 2014 by Rowman and Littlefield. Latest book- The Uninformed Voter published May 2020