Word: carefuls
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...Alas, there's no proven link between more spending and better care. The good news is that parts of the country provide care at a low cost, so there's potential for gigantic savings if the rest of the U.S. could imitate them. One Dartmouth study found that if nationwide spending had mirrored the modest rate of that in Rochester, Minn. - where care is dominated by the renowned Mayo Clinic - Medicare would have reduced its costs for chronically ill patients by $50 billion from 2001 to 2005. As the old inflation-adjusted saying goes, pretty soon you're talking about...
...unnecessary costs are another man's profits; lobbyists for drug- and devicemakers, hospitals, doctors and insurers are already fighting to make sure their slices of the more than $2 trillion health-care pie aren't nibbled by reform. Senate Republicans just introduced "antirationing" legislation to bar the government from using comparative-effectiveness research - "a common tool used by socialized health-care systems" - for cost control. They paused in their usual attacks on Obama's profligacy just long enough to attack his stinginess, warning that he will use evidence as an excuse to micromanage the art of medicine, stifle innovation...
...spends more on health care than any other country does, and studies have suggested that as much as 30% of it - perhaps $700 billion a year - may be wasted on unneeded care, mostly routine CT scans and MRIs, office visits, hospital stays, minor procedures and brand-name prescriptions that are requested by patients and ordered by doctors every day. Orszag is particularly obsessed with research by the Dartmouth Institute for Health Policy and Clinical Practice, documenting huge regional variations in costs but virtually no variations in outcomes. For example, chronically ill patients in Los Angeles visited doctors an average...
...effective enough - or, more controversially, cost-effective enough - to be reimbursable. Medical knowledge is constantly evolving, and treatments that seem to lack solid evidence today might seem indispensable tomorrow. Wasteful tests and procedures don't come with labels marked "wasteful," and most patients and providers genuinely believe the care they're getting and giving is necessary. Comprehensive studies of what works can be slow, expensive and inconclusive. Even Orszag admits the savings from cutting out unneeded care would take a decade to materialize...
...Still, those savings could mean the difference between national solvency and fiscal catastrophe, so Obama is targeting two major barriers to data-driven medicine. The first is the perverse "fee-for-service" incentives that now plague our health-care system: hospitals get paid more if you stay longer and come back often; doctors get paid more if they do more tests and procedures - and you come back often. More services, more fees. "You've got to follow the money," says former Senator Tom Daschle, Obama's initial choice for health czar. "We reward volume, so that's what...