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.