Archimedes Movement Community Leadership Council member Mike Grady, M.D., had the following opinion piece published today in the Oregonian:
We will have health care reform by the holidays, but it won’t be what we need.
The $265 million spent by the health care industrial complex on lobbying in the first half of this year, and the millions to follow, guarantee there will be no robust public option. Gone will be our best hope of curtailing the health insurance, drug and device industries that have failed to give us value for our health care dollars.
But it’s our stubborn refusal to discuss what a just and sustainable public benefit for health care should contain that ensures that changes to the system will be cosmetic. In particular, the failure to substantively address Medicare continues our national delusion that we can ignore the unfunded liability of this program over the next 25 years.
The projected shortfall for Medicare, in the tens of trillions of dollars, will make our current concern about $1 trillion in new health care spending seem silly. The problem with Medicare is the problem with insurance in general: It is designed in a way that encourages providers and patients to get as much as they can from it.
In his recent article in The New Yorker, Atul Gawande brings attention to information that we’ve known about for 20 years. There is a large regional variation in the delivery of medical care services, with more expensive care not producing better health outcomes. This variation is not only expensive, but also harmful and even shameful. There are too many physicians who view their patients as profit centers.
But medical providers are only half of the problem. For every unnecessary test or procedure, there is a patient who equates newer with better, and more health care with better health care.
Physician self-interest, a cultural inclination to uncritically embrace new technology and an unwillingness to accept limits, especially at the end of life, have produced a perfect storm of unsustainable utilization of the Medicare benefit and commercial insurance.
Our societal task is to identify those health care goods and services that provide the most benefit for the population consistent with the best evidence available and incorporating the agreed-upon values of the community. We need to end the senseless arguments about rationing. Public resources for health care are scarce. It’s not a question of whether we ration, but how.
Single-payer advocates have used the mantra “Medicare for all.” But a more appropriate public program that could potentially model a sustainable core benefit for all Americans is Medicaid. This combined state and federal program for the poor has a better record of controlling the benefit in a cost-effective manner. With modifications, it could serve as the core publicly provided benefit for all Americans, with private insurance serving a large secondary insurance market for those willing and able to pay for additional coverage.
“Medicaid for all” — with global budgeting, prioritization of services determined using the best available evidence in a politically protected process, available to and paid for by all Americans — is a more sustainable model for publicly funded health care in the United States.
Michael Grady is a family physician in Silverton and serves on the Community Leadership Council of the Archimedes Movement.
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