Finding the correct prescription
WASHINGTON – Here’s a radical idea for reframing the healthcare debate on the ruins of the GOP’s half-baked plan: Let’s listen to doctors, rather than politicians. And let’s begin with a simple formula offered last week by the National Academy of Medicine: “Better health at lower cost.”
Better and cheaper. It’s hard to argue with that prescription. Because the real health-care crisis in America is about delivery of care, more than the insurance schemes that pay the bills. Costs are continuing to rise, even as public health in America declines. We’re getting less for more. And the GOP’s proposal to starve Obamacare will make that downward spiral worse.
Watching the Donald Trump “repeal and replace” debacle play out on Capitol Hill drove me to the doctor — specifically, to Dr. Delos “Toby” Cosgrove, the head of the Cleveland Clinic. Cosgrove is one of medicine’s visionaries — sought, unsuccessfully, by both the Obama and Trump administrations to head the Veterans department.
I asked Cosgrove how sensible people should think about health-care reform, now that there’s an opportunity for a fresh start. He offered pragmatic advice that’s neatly condensed by the Academy of Medicine report: Government should help health care professionals get the incentives right, so that they provide better output (care) with fewer inputs (cost).
Americans don’t realize just how bad our system is. Health-care costs are far higher in the U.S. than other developed countries, but our health is worse. That’s especially true among older whites without a college education — Trump’s core demographic — whose mortality rates are rising alarmingly.
Life expectancy is declining in America for the first time in nearly 20 years, according to the Journal of the American Medical Association. And the gap in life expectancy between the richest and poorest Americans is 15 years for men and 10 years for women.
The problem certainly isn’t that America doesn’t spend enough. The U.S. now pays $3.4 trillion annually. But the Academy of Medicine study estimates that 30 percent of this money is wasted on unnecessary services, high prices, inefficient delivery, excess administration and fraud.
These problems long predate Obamacare. Health-care expenditures have risen as a percentage of GDP from 5 percent in 1960 to 17.8 percent in 2015. The cost of government health programs has increased by an astounding 63-fold since 1974, according to the Congressional Budget Office.
The Academy offers a four-point plan for altering this bad combination of high cost and poor care. First, providers should be paid for value — for patient outcomes, not the volume of procedures. Second, incentives should empower people to take better care of themselves through wellness programs or lifestyle changes. Third, better connectivity is needed among doctors, patients and others to encourage data-driven advances.
Finally, the Academy argues for community strategies that target the highest-need patients, who are also most costly to treat. The top 5 percent of spenders, often with multiple conditions brought on by obesity or other chronic conditions, account for 50 percent of total U.S. health outlays.
How would such reforms work in practice? Cosgrove cites his experience at the Cleveland Clinic, which is Ohio’s second-largest employer and provides health insurance for more than 80,000 employees and family members.
The Clinic shocked people in 2007 by announcing it wouldn’t hire smokers; since then, it has added many incentives for employees to stay fit and be healthy. Sick days have declined 28 percent; the percentage of eligible employees using preventive care for chronic disease has increased from 9 percent to 54 percent; employee health costs have fallen 2.2 percent since 2012.
Health care isn’t a political football. Americans should be embarrassed by our system’s performance. As the Trump administration works with Democrats to reformulate health legislation, maybe this time they can agree on reforms that actually treat what’s wrong.
David Ignatius is a columnist for the Washington Post Writers Group. Contact him at davidignatius@washpost.com.