Last week, The Michigan Daily published an editorial that ended with the telling observation that the United States spends “more than any other developed nation” on health care, yet ranks “37th out of about 191 nations” in “overall healthcare quality.” While the poor cost-quality ratio of American medical care is troubling, it’s unlikely that the changes implemented by President Barack Obama’s Affordable Care Act will have maximal effect without a few added considerations.
For one, the Affordable Care Act doesn’t address the potential savings promised by the use of comparative effectiveness research in the national health care system. Comparative effectiveness refers to a process by which statisticians compare several forms of treatment for the same illness. Some treatment methods vary widely in cost yet are strikingly similar in their ultimate outcomes. A 2009 New Yorker investigative piece focused on the town of McAllen, Texas, which has the most expensive healthcare costs in the country. The article discussed the widespread practice of “overutilization,” in which doctors administer multiple unnecessary tests — sometimes to get more money out of a patient, other times to prevent the slightest possibility of a lawsuit — that basically amounts to sanctioned fraud.
By “sanctioned,” I’m referring to the fact that our current health care industry is exploiting our trust in the old maxim “you get what you pay for.” According to the New Yorker article’s primary research, “the more money Medicare spent per person in a given state the lower that state’s quality ranking tend(s) to be.” The article also draws from outside research to posit that oftentimes, patients in costlier areas of the country “d(o) no better than other patients, whether this was measured in terms of survival, their ability to function, or satisfaction with the care they received.”
Since the current healthcare system compensates practitioners under a “fee-for-service” system rather than with an annual salary, there’s an inherent motivation to test a patient to death, racking up charges that have no measurable effect on the outcome of the treatment method. I never thought I’d say this, but given these conditions, it’s hard not to equate America’s medical practice with its cell-phone industry.
Though there’s a provision in the Affordable Care Act for a pilot program that would address the varying expenses of Medicare coverage by region, there’s no guarantee it’ll catch on as a long-term strategy. Furthermore, the act does little to eliminate the overhead costs incurred through the unnecessary mediation of third-party insurance companies. A single-payer universal healthcare system would maximize savings, if not by eliminating wasteful practices, then at least by limiting the waste to a single source of healthcare rationing — the federal government.
Obama’s healthcare reforms may be a step in the right direction, but they’re not the long-term solution Americans have been looking for. It’d be best to view it as a bridge between the old system and a comprehensive new one, in which everyone receives treatment relative to their lifestyle choices and a contribution proportional to their income level, rationed out by a single pool of health care investments.
Tim Rabb in a senior editorial page editor.