Controlling costs crucial in righting health care

The headlines are ablaze with news of a near-universal health plan and a way to pay for it. President Barack Obama is asking Congress for a bill by August. That would be the month right after this one.

This is momentous, not just because the government is dramatically overhauling health care delivery, but because this is the optimum time to get it right. And the key to getting it right is controlling costs, because health care inflation is crowding out spending on education, energy, defense, law enforcement and other basics. On Thursday, the Congressional Budget Office reported that the Democrats’ bills would not stem rising costs.

The United States spends a significantly higher sum than other industrialized nations on health care without better outcomes overall to show for it. Even within the country, some regions spend more than others without raising the quality of care. In short, we have an inefficient system.

But there are profits in waste, so it will be defended.

One of the prime tactics is to call efforts to achieve greater efficiency “rationing.” This conjures images of patients with life-threatening ailments being turned down by government bureaucrats. That’s not going to happen with vital treatments. Plus, millions of people who aren’t covered self-ration by not getting needed treatments.

The efforts to defend inefficiency go so far as to oppose reviews into the best practices for particular maladies. So-called comparative-effectiveness research received $1 billion in stimulus money, and defenders of the status quo pounced, calling it unwarranted government interference between doctors and patients.

But it is warranted, because the rising cost of health care affects us all. Cost-benefit analyses and adhering to best practices are vital to reining in health-care inflation. We must set priorities and closely scrutinize spending on procedures and treatments with low chances for success. This is especially true with end-of-life care and heroic measures to save extremely premature babies. In some cases, extending care to all would mean limiting care for some. These are hard choices, but we can’t avoid them.

In addition, the concept of having a “medical home” – also known as the Mayo Clinic model – could extract huge savings and deliver better outcomes. At Mayo, doctors on salary work as a team. They are in constant communication and aren’t pressured by a fee-for-service model to move on to the next patient or quickly order expensive tests.

That’s not rationing; it’s rational. But it does fly in the face of our more entrepreneurial health care system. Even under cost controls, patients could still get no-holds-barred care, but they would have to pay for it. By the same token, we cannot cover every elective procedure and hope to control costs. Insurance companies already “ration” in this way.

Congress and the president are undertaking an enormous task in trying to change health care, but if the looming deadline forces them to skimp on cost containment, the final product could be irretrievably flawed.