A stimulus for health care reform
Whenever this tsunami of acute economic problems finally ebbs, the chronic problem of out-of-control medical costs will take center stage as an impediment to a healthy future.
Unless surging costs are arrested, the federal treasury will be depleted by the exploding cost of Medicare and Medi-caid. More private employers will drop coverage as they seek to improve their competitiveness, and more people will be forced to buy their own insurance - if they can afford it. Many can't, and that will swell the number who rely on costly emergency rooms for care.
Ultimately, it may take broad reform to fashion an affordable, sustainable health care system. But we can't wait for the big cure. Despite epic economic distress, the effort has to start now.
Fortunately there are signs that Washington and Albany get it. The stimulus bill that President Barack Obama signed this past week included money for research into the comparative effectiveness of different treatments for the same illness, and for computerizing medical records. And officials in both capitals are pushing to expand the number of people who have insurance.
Americans will pay $2.6 trillion for health care this year. According to the Congressional Budget Office, that's $8,300 per person, or 18 percent of GDP. If we continue on the current course, by 2017 that will rise to $13,000 per person, or 20 percent of GDP.
With so much money being doled out for medical procedures, drugs and the latest devices, it would help to know which treatments, among the myriad possibilities, deliver the best results. But little has been done to look carefully at clinical effectiveness and cost, to gauge the value of competing treatments. The stimulus bill committed $1.1 billion to that important task.
Effectiveness research will be controversial. There's already concern that insurers will use the data to deny payment for certain procedures. That has some fretting that statistics will be substituted for medical judgment. How the data should be used must be carefully sorted out. But the essential first step is to begin collecting and sifting.
Another important initiative embedded in the stimulus bill is $19 billion to accelerate the adoption of health information technology by doctors and hospitals. Making files available, at the stroke of a keyboard, to doctors anywhere a patient turns up for care, should reduce errors and duplication of costly tests. And that should save lives and money. Protecting patient privacy will be a challenge. But that's a problem to be solved, not a reason for inaction.
Progress in computerization and gauging the effectiveness of competing treatments should pay dividends in time. But in the interim, more people need to be covered by insurance.
The expansion of the State Children's Health Insurance Program (SCHIP) that Congress approved this month will help. The number of children covered will increase from 7 million today to 11 million in 2013, with tobacco taxes picking up the tab.
Another step in the right direction, this one in the stimulus bill, is Washington's decision to help people collecting unemployment compensation by picking up 65 percent of their cost, under COBRA, to buy nine months of coverage in their former employers' medical plans.
The state is also making an effort. Gov. David A. Paterson wants to allow parents to carry their children on family health insurance policies until age 29, rather than the current age limits of 18 for most and 22 for those in college. The legislature should support the initiative.
State officials also are working to change how Medicaid reimburses inpatient and outpatient care - to encourage patients, if possible, to go to doctor's offices and clinics, where care costs less.
As the huge Baby Boom generation ages, the demand for care will grow. So will the burden of paying the bills. With the economy in distress, for the time being baby steps toward a more affordable system may be the most we can do. It's also the least we should do.
