Home > Health care, Media fail, Money changes everything > Special interests feast at health-care trough

Special interests feast at health-care trough

If all U.S. health-care providers and organizations followed the lead of those who deliver high-quality care at 20% less cost than the average, health-care spending would retreat from 17% of GDP and we would have a $640 billion windfall to apply to other needs.

What stands in the way? Too many individuals and organizations are enriched by the current system and don’t want to change it, according to two prominent physicians who ask “Why Does Cost-Effective Care Diffuse So Slowly?” at the New England Journal of Medicine’s Health Policy and Reform website.

“The answers to this $640 billion question lie in the perceptions and behaviors of the major participants in health care,” say Drs. Victor Fuchs and Arnold Milstein.

For example, health insurance plans don’t want to standardize coverage or administrative processes to save $200 billion a year because that could end up putting downward pressure on profits…and executive pay. Hospital administrators oppose efforts to reduce admissions and occupancy because lower revenues would make it harder to cover fixed costs. Physicians object to any reforms that reduce individual autonomy (to disregard evidence and practice as they please) or alter fee-for-service payment systems that reward specialists for doing more treatments. Legislators are too busy collecting campaign contributions from healthcare interests that benefit from the current arrangements to try to reform the system.

Of course, Fuchs and Milstein agree, the folks with the most to lose are the drug-makers and device and equipment manufacturers

Marketing to consumers and physicians will be much less successful if purchasing and prescribing decisions are made by organizations such as managed-care plans or accountable care organizations that … have the incentive and the ability to evaluate competing products and can negotiate with suppliers for the best value. To preserve the present system, manufacturers of health care products spend heavily on federal lobbying.

Sounds hopeless, doesn’t it? Nevertheless, Fuchs and Milstein call on their professional colleagues to lead the charge:

…physicians are the most influential element in health care. The public’s trust in them makes physicians the only plausible catalyst of policies to accelerate diffusion of cost-effective care. Are U.S. physicians sufficiently visionary, public-minded, and well led to respond to this national fiscal and ethical imperative? It’s a $640 billion question.

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