Friday, December 11, 2009

Will Reducing Health Care Costs Kill Patients?

David Leonhardt, economics columnist for the New York Times, continues to do superb reporting and analysis of our health system. Print journalists don't have the reach of the right wing talk show blowhards, but a steady drum of thoughtful, informed voices like Leonhardt can chip away at the flood of disinformation we receive.

I just came upon his column from a couple of days ago and wanted to toot the horn for it. Here's an excerpt:
The House has shown little interest in cost control. President Obama and his administration have pushed aggressively for it, but they have limited leverage. Mr. Obama can’t credibly threaten to veto any of the health reform bills that now seem likely to emerge from Congress.

So after the 11 [Senate] freshmen announced their [cost-cutting] plan on Tuesday, I caught up with Mark Warner, the Virginia Democrat who is the group’s leader, underneath the Capitol building and asked him how he and his colleagues would deal with the inevitable scare stories still to come: How do you respond to a lobbyist who effectively accuses you of killing patients?

“I don’t know any other way than you take incremental steps,” Mr. Warner said, “and you hope you get to the tipping point where fear and misinformation don’t have an effect, because people see these things don’t do what they are accused of doing.”

That, obviously, is the long-term strategy. In coming weeks, we’ll see how well Mr. Warner and his colleagues deal with the immediate pressure. The Grim Reaper is a tough opponent.
I encourage readers - especially those from outside of the U.S. who are struggling to fathom what on earth is going on in our health reform process - to look at Leonhardt's full article. (And for a previous post on Leonhardt's discussion of rationing, see here.)


Ross Neisuler said...

It is important to emphasize how expensive and destructive irrational care and maldistributed care is right now. Good care is actually less expensive than sloppy market-driven care and of course more ethical. If we can drive down expenditures by reducing the dangerous overuse of expensive procedures and drugs and all the complications which follow from them, we will have a lot to spend on what is productive of health. At present, dangerous practices and prescribing are resulting from market forces, advertising, and the need to do many procedures to justify capital expenditures and amoratize capital costs.

Jim Sabin said...

Hello Ross -

It's always good to hear from you! Thanks for your comments.

I know that you have decades of evidence for the truth of your comments from your own primary care practice. You and I were both salaried physicians in a not-for-profit, clinician governed group practice. One good thing that appears to be happening in the context of the health reform effort is a broadening consensus that fee-for-service payment encourages fragmented, "high tech/low touch" medicine.

I would add to your comment that "good care is actually less expensive than sloppy market-driven care" that in addition to being better for the patient and less costly, it's more satisfying to the clinician. That's the truly win/win/win direction that we have to steer our health system towards!