It's good that healthcare expenditures and the state of the system gets attention by the Federal Reserve Chairman. He speaks about the iron triangle of healthcare, that every medical student knows about - access, quality, and cost - and how any country or organization only optimize two of three. Unfortunately, we rank the lowest in the world among industrialized countries with higher costs per capita, poor access with 47 million uninsured, and the worst quality outcomes as we don't live the longest. The iron triangle doesn't permit universal coverage with the highest quality at the lowest price.
He correctly notes that "the solutions we choose for access and quality will interact in important ways with the third critical issue--the issue of cost. Greater access to health care will improve health outcomes, but it almost certainly will raise financial costs. Increasing the quality of health care, although highly desirable, could also result in higher total health-care spending. For example, increased patient screening may avoid more serious problems and thus be cost-saving, but it could also identify problems that might otherwise have gone untreated--a good outcome, certainly, but one that increases overall spending. These are certainly not arguments against increasing access or improving quality. My point is only that improving access and quality may increase rather than reduce total costs." Any who claims that fixing the healthcare system will make it cheaper is incorrect. Mr. Bernanke is right to ask the question "whatever we spend, is whether we are getting our money's worth"?
In a previous post, I reviewed succinctly what you must know about healthcare reform. From the article regarding the Fed Chairman:
- "Improving the performance of our health care system is without a doubt one of the most important challenges our nation faces," he said.
- On the health care front, Bernanke didn't recommend specific solutions, saying the difficult choices involved with improving access and quality and controlling costs were best left to policymakers in Congress, the White House and elsewhere.
- "Taking on these challenges will be daunting," he said. Given the complexity of health care matters, he suggested that it might be better for policymakers to consider an "eclectic approach," rather than one single set of reforms to address all concerns.
- "We may need to first address the problems that seem more easily managed rather than waiting for a solution that will address all problems at once," Bernanke offered.
Here's my take on Democratic nominee Senator Obama's and Republican nominee Senator John McCain's healthcare proposals.
I think the improvement of the healthcare system won't come from policymakers or the White House. For reform to occur it will take all participants in the system, employers, insurers, patients, doctors, hospitals, pharmaceutical companies, the government and many others to come together and work towards a solution. It will occur when patients are true consumers and shop around for the best care, not necessarily the cheapest, and patronize those services like they do other consumer products. Understandably, patients don't want this responsibility, so who else might fix the system? Employers who purchase healthcare? The providers who deliver it? Sounds like the status quo.
Unfortunately, no one is willing to step up and begin the painful and necessary process to reform the system. Costs will continue to simply spiral out of control. The public and employers will either drop health insurance benefits or purchase less comprehensive deductible products to maintain coverage.
Conclusion? Our country will end up with many more being uninsured, others not getting preventive care or delaying care due to the deductibles, and a workforce that will be increasingly unhealthy and unable to compete in a global market. As an insider, as a doctor, I know when to seek care and when to safely skip care, but what about the rest of us? Specifically, what about you? How are you feeling about your chances? Not feeling too optimistic are we?