Marmor told us that in order to control the costs of medical care, you have to constrain the price of medical services, the number of those services, or a combination. As the KPCC discussion turned toward cost control, Marmor argued that improving medical quality was not a pre-condition for controlling costs. He then attacked the tax on so-called Cadillac plans, the cost containment solution of the moment. If workers want treatments not covered by their trimmed-down plans, they will have to pay on their own or go without. The expectation is that many will go without, thus reducing the number of medical services people use. It doesn’t do much for the price side of the equation.
On KPCC, Marmor pointed out that when medical personnel are paid for each activity performed, all hell breaks loose if there are no budgets to limit spending or in some way “fiscally constrain the amount [of money] available.” What is striking, Marmor said, is that there has been almost nothing said about these cost-control mechanisms. He mentioned Canada, where residents have what would be considered Cadillac plans in the U.S.—no coinsurance, deductibles, or copayments. Yet that country’s medical expenditures are thirty to fifty percent less than ours.
Leonhardt countered that the political reality meant the U.S. was not going to build a health system from scratch, so cost containment strategy centers on throwing “lots and lots of cost reduction ideas on the wall and hope that one of them sticks.” Ah! The spaghetti-on-the-wall approach. Makes perfect sense, except if premiums are unaffordable for your family.
Before more Americans are misled into thinking that affordable, quality health care is around the corner, the press needs to set the record straight and bring some new voices into the mix. Here’s one time where balance is appropriate. I’d even settle for some “he said, she said” on this one.

Increased consumer choice, comparative effectiveness, health IT, preventive care are all excellent ways of saving money and controlling costs. (Mind you, people are going to demagogue on comparative effectiveness if the government suggests something like "Mammograms for 20 year olds are not effective." Oh yes, it will be "DEATH PANELS DEATH PANELS DEATH PANELS!", shrilly screamed until your ears bleed and you need to seek a neurologist for the pain)
What I think is missing is the discussion of what Atul Gawande nailed in the "Cost Conundrum" article.
http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande
The Mayo Clinic keeps quality high and costs low because of the culture they encourage. This culture doesn't prioritize revenue generation or patient throughput, it prioritizes quality treatment and team coordination. The staff are paid salaries to take individual profit motives out of the equation and staff from the janitor level to the surgeon meet to discuss quality issues and improve their services. These are very reminiscent of Japanese developed quality production techniques.
Government policy should be nudging hospitals to adopt these techniques.
And taxing generous health plans is stupid loser politics. Honestly, who writes these policies suggestions?
#1 Posted by Thimbles, CJR on Thu 3 Dec 2009 at 10:36 AM
Mind you, people are going to demagogue on comparative effectiveness if the government suggests something like "Mammograms for 20 year olds are not effective." Oh yes, it will be "DEATH PANELS DEATH PANELS DEATH PANELS!"
Why Coburn? Why must you be such a tool (of industry)?
http://www.youtube.com/watch?v=7LyEqrVuiQM
#2 Posted by Thimbles, CJR on Fri 4 Dec 2009 at 12:15 AM