Too much of healthcare costs is out of providers’ control

The article “MedPAC recommends 3.3% raise to hospitals in 2021” (ModernHealthcare.com, Jan. 16) noted: “The Medicare Payment Advisory Commission voted to recommend increasing payments to hospitals, but it wants them to rely less on fee-for-service and boost quality and efficiency.”

The concept of hospitals being accountable (penalized) for the entire cost of patient care is ludicrous for a variety of reasons.

First, absent hospital-owned physician practices with very tight parameters on practice patterns, the assumption that hospitals have any measurable control over outpatient costs of care is flawed. Physicians, too, are for the most part paid on FFS models, thus incentivizing them on volume instead of quality and efficiency. Even under ACO models, data suggest there is minimal impact on total costs.

Second is patient autonomy. We can educate, counsel and follow up with home care, but patients ultimately choose how they want to manage their health. Despite aggressive initiatives, we continue to experience epidemic obesity, Type 2 diabetes and smoking-related conditions associated with lifestyle choices. We don’t live in a police state, and cannot legislate behaviors.

Finally, there’s the cost of drugs. With the unbridled advertising of the latest, greatest med on every single TV program, patients are demanding access to these meds, regardless of the cost. And often they wouldn’t be the most effective choice.

America is at a turning point in healthcare. Are we going to continue with open access or are we moving to a socialized model that offers healthcare to all? I seriously don’t think most Americans are ready for European and Canadian models of healthcare in which a higher power decides who gets care and when.

Denise Adema Fort Myers, Fla.