Keeping the “best care” option out of the health spending equation

Remapping Debate asked the advocates of reducing utilization whether a better starting point might be an evaluation of what it would take to move all Americans to the highest possible level of care, an assessment that would allow for open and transparent decisions as to the extent that we as a society should pay for such care or deny such care.

When asked why that wasn’t her preferred course, Rice’s Vivian Ho said, “Because we’re spending too much money right now.”

Tracy Miller, an associate professor of economics at Grove City College, acknowledged that that path might mean less immediate risk to patient health, but said that the increased spending necessary to achieve it would require either reduced spending in other areas or tax increases.

When asked whether Americans might tolerate an increase in taxes if what they would be getting — improved health care — was clearly apparent to them, Miller said that they might. But when asked whether he was in favor of taking such a path, he said, “Obviously it’s a matter of priorities, but in my personal view, we’re spending too much tax revenue on health care as it is.”

A different starting point?

J. Sanford Schwartz, a professor of medicine and health care management at the Wharton School of the University of Pennsylvania, told Remapping Debate that the continuing focus on reducing the amount of care conceals the fact that we are actually making choices about what kinds of care we want to provide, and that those choices have
consequences.

“The vast majority of what people call overutilization is care that involves tradeoffs between costs and benefits,” he said. “The conversation we should be having about those services is whether we’re prepared to pay the cost to get the benefits. That’s different from saying, ‘We’re doing too much, let’s cut back.’”

That sentiment was echoed by several of the physicians interviewed for this article. “I think there are a lot of people out there who have an agenda to cut healthcare costs,” said Daniel Barocas of Vanderbilt University. “Before we do that, I think we need to have an honest conversation about what kind of health care system we want in this country, and that isn’t what has been happening.”

Arthur MacEwan, a professor emeritus of economics at the University of Massachusetts Boston, said that we would be in a better position to have that conversation if instead of beginning from the assumption that we’re spending too much money on healthcare, we began by asking what it would take to get the highest possible quality of care to the greatest number of people.

If providing such “Cadillac” or “gold-standard” care to everyone is “going to cost more than we can afford,” MacEwan said, “then maybe we have to do less, but at least we would be making conscious, informed decisions.”

Don McCanne, a family practitioner and senior health policy fellow at Physicians for a National Health Program, a group that advocates for a single-payer health system, agreed and added that from that perspective, the gap between the care that Americans currently get and what would be considered a “gold standard” of care could well become a matter of more urgency than the costs.

“If we were looking at it that way,” McCanne said, “I think the first thing we might see is that there are millions of people who are not getting the care they need right here and right now.”

Additional reporting by Craig Gurian.