Chal­leng­ing de­ci­sions on the fu­ture of health care

The Denver Post - - PERSPECTIVE - Re: Ken Lieb,

This ar­ti­cle, which touts a “Medi­care for all” ap­proach, notes that 20 per­cent of the pop­u­la­tion ac­count for 80 per­cent of to­tal health care spend­ing, “most of this com­ing from Medi­care and Med­i­caid.” There­fore, any mean­ing­ful at­tempt to con­trol health care costs must ad­dress the mas­sive costs in these pro­grams. The ar­ti­cle fails to ad­dress Med­i­caid re­form but does pro­pose a rea­son­able “fix” to Medi­care — al­low­ing the gov­ern­ment to ne­go­ti­ate drug costs. Do the au­thors be­lieve this one ac­tion will con­trol health care costs for the “sick­est” 20 per­cent of the pop­u­lace?

The ar­ti­cle cites a study which states that about one-third of health care costs can be at­trib­uted to fraud waste and abuse, and later concludes that “im­proved Medi­care ... will dra­mat­i­cally re­duce waste, fraud and abuse.” How?

Ul­ti­mately, health care sys­tems must an­swer two ques­tions: who pays for the sick peo­ple (the 20 per­cent ref­er­enced in the ar­ti­cle); and who says “no” and when. The lat­ter point con­cerns the real­ity that our so­ci­ety does not have in­fi­nite re­sources to pay for every med­i­cal pro­ce­dure that every per­son might some­day need.

A “Medi­care for all” pro­gram could pro­vide cover­age to the “sick peo­ple,” but with­out some kind of ul­ti­mate lim­its on care, an in­abil­ity to say “no” would eco­nom­i­cally doom it. This in turn re­quires tough de­ci­sions that are chal­leng­ing (to put it kindly) in a highly politi­cized world.

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