Now that President Bush has won a second term, there's a temptation to say the status quo prevails in healthcare, but don't be fooled. Healthcare needs are big enough to bully their way into the Oval Office and the halls of Congress whether they're welcome or not.
The election settled many political scores, but it didn't solve problems. Health costs continue to grow at roughly twice the rate of general inflation, threatening access to care for many Americans, 45 million of whom already lack coverage. Quality of care remains appallingly inconsistent across the country despite some isolated pockets of excellence. Employer-sponsored coverage may not be on life support yet, but it's getting prepped. The new Medicare drug-benefit program is deeply flawed. In the not-so-long term, tens of millions of baby boomers will morph into senior citizens, and whether or not they are healthier than prior generations of geezers, they will seriously tax our resources. One- quarter or more of our hospitals are in financial trouble.
Now is the time for leadership on these issues, which involves the kind of tough choices this administration has heretofore been unwilling to make. For example, the Medicare Modernization Act had absolutely no cost controls other than those borne by beneficiaries. Bush and/or Congress should stand up for once to the drug industry lobbyists and allow the CMS to negotiate bulk discounts on drug prices, just as the Veterans Affairs Department health system does. The savings can be used to enhance the prescription drug benefit and lower the cost of the program.
We also need to invest in access to care for those who can't afford private insurance. Bush wants to expand tax breaks for lower-income Americans who buy their own insurance and for those who purchase high-deductible policies that include health savings accounts. This may be fine for healthy young people but not for those who are sick, can't afford the deductibles and don't spend a lot of time worrying about tax forms. Instead, we should be doing everything we can with the tax code to protect employer-sponsored care while opening up existing government programs to the working poor who have no coverage.
More than anything, the government must invest in our healthcare system in order to wring savings out of it in the long haul so that more people can be covered. We lead the world in our life-saving medical technology and overall health spending, but achieve some of the lowest scores among developed countries in life expectancy and other measures. As much as 30 cents out of every dollar spent on care is wasted. We need to use payment processes to encourage providers to use only the treatments that work. Outcomes reporting must be mandated.
One of the bright signs in this administration has been funding for the National Institutes of Health. We need to continue to escalate our investment in clinical research on which treatments are most efficacious and cost-effective. We must invest in information technology so that that information can be promulgated in the form of clinical protocols, lives can be saved through fewer medication errors and the inefficiencies of paper records can be reduced. A modest, need-based federal financing program would help those safety-net hospitals that lack access to IT capital.
Nobody is saying that any of this is easy or inexpensive. Even if all of the waste was wrung out of the system and all of the right care provided, we still would face the challenges of caring for the baby boom generation and paying for advances in medical technology. If we don't act soon, our current system of care is in danger of imploding. That's a threat from which you can neither run nor hide.
What do you think? Write us with your comments. Via e-mail, it's [email protected]; by fax, dial 312-280-3183.