The most important fiscal work before America right now is slowing growth in health care costs without impacting patient care.
A key to that is changing medical business models, moving from fee-for-service systems where all the incentives are to spend more toward fee-for-patient models where wellness can turn a profit.
The biggest buyer of healthcare is the U.S. government, and their biggest buyers are Medicare and Medicaid. The Centers for Medicare and Medicaid Services (CMS) need to speed up their usual 3-5 year pilot program process on these business models because we can't wait that long, the Joint Commission argues.
Few doubt there are billions to be saved, not just in chronic conditions but in simple overtreatment, a reliance on tests that lead to expensive interventions.
Researchers at Dartmouth have long argued there are large regional disparities in testing and treatment that don't pay. People don't live longer in Lubbock, Texas than in Waco, they argue. So why do Medicare patients in Lubbock pay twice as much, on average, for care?
The response of those in industry who don't want change is to attack the Dartmouth study, and the same thing is playing out at CMS, where the nomination of Dr. Donald Berwick is being held up by Republicans who claim he supports rationing of care.
(Above is the leading hold-up, Sen. Pat Roberts of Kansas. The link is to his statement on the matter, and the picture is from his Web site.)
The charge is a nonsense. As is the claim Dr. Berwick supports a nationalized system like the British NHS. But if Berwick can be kept out of CMS, he can't accelerate the business model changes needed to make savings happen.
It makes me mad, and it should make you mad, too. It's not just Medicare and Medicaid that need new business models. Private insurance needs them, too. But private industry can't move until the bigger player moves -- their customers would not accept it.
While the politicians fiddle our fiscal house burns. Some of Berwick's opponents are at least honest, calling for an end to Medicare and Medicaid in the name of freedom. Others, like Roberts, are just playing a game of chicken with the public and private purse.
For your costs to fall, wellness must have a profit. We need financial incentives to stay out of the hospital, avoid unnecessary tests, and get sick less.
No one knows more about how to save money without reducing needed care than Dr. Donald Berwick. This is not a partisan point. Previous CMS directors Gail Wilensky (Bush I) and Mark McClellan (Bush II) agree.
As the present system causes costs to rise every year by double digits, more and more middle class people are seeing themselves rationed by economics into early graves.
Keeping the best reformers from trying to make change isn't going to extend grandma's life by one day.