Necessary Change

During the first one-hundred days of Obama's presidency there have been many debates about health care. Many democrats such as senators Max Baucus (Mont) and Ted Kennedy (Mass) have been eyeing health care reform down for a long time. But they aren't the only ones. Another notable democrat Peter Orszag, the new Director of the Office of Management and Budget, has a few ideas of his own.

Orszag's opinions have garnered a little bit of attention in the past few months. For one, he has asserted that without controlling health care costs we will persist to have an intractable budget and worsening debt. He's right, but that's old news. Most of those in the government know that we need to control health care costs, but few have proposed any ideas like his.

The traditional way those in government, especially republicans, have addressed controlling health care costs is by altering how it is paid for. Either through alterations in medicare or medicaid (to try and reduce the government's burden) or through increasing "market competition" (to lower rates on private plans). And yes, altering the way we pay for health care can help control costs and this should be thoroughly addressed -- you'll notice single payer insurance hasn't been realistically considered as an option.

However, Mr Orszag has brought to attention an important fact: the way health care is delivered also needs to be changed. As the Ney York Times reported, "to address the problem, he wants to do no less than change the way medicine is practiced, eliminating unnecessary tests and unproven treatments in favor of what he calls a higher-value approach that he says will actually improve health."

I touched on this a bit the other week in my post "Why Are Costs So High?". In it I comment on the fact that we tend to utilize expensive procedures and options much more often that other countries. However, we don't have any markers that show we get added health benefits above and beyond other countries. In fact, it is quite the opposite. With our higher infant mortality rates and lower life expectancy, we rank as one of the lowest developed countries in terms of health.

In his book Introduction to Health Policy, Dr Donald Barr M.D. also talks about excessive tests and unproven treatments especially when it comes to new technology. The history of treating high blood pressure is a useful example. Traditionally, physicians prescribed relatively cheap diuretic pills to patients for their high blood pressure. Then calcium-channel blockers became popular in the 1980's. Again, in the 90's a new category of drug called an ACE-Inhibitor became widely used. There was a problem though. To physicians, the efficacy of these treatments was inherent in the fact that these pills were new and not necessarily that they were any more effective.

Don't get me wrong. They obviously worked because patients were getting the results they needed. However, It took nearly two decades for clinical evidence to surface that showed the newer treatments were no more effective than the older diuretics. Plus when you take into account that these pills cost 10-15 times more than the $10 diuretic pills, you start to understand the usefulness of having a system of evidence-based medicine: practicing medicine that is put up against the scientific-method to assess the quality of evidence on a cost-effective basis.

And that is just one area in which we can change how health care is delivered. There are other ways in which we can save money and change the delivery of care. And that will be essential to fixing our health care problems. Focusing only on the financing of health care alone (ie. single-payer) isn't going to solve the problem of increasing health care expenditures. Only a comprehensive approach will.

- m.tsang