The media has been paying too much attention to the lies about health care reform that the conservatives have been circulating. Perhaps this is understandable: they are Big Lies, colorful canards, horrifying rumors. But they are simply, totally wrong—made up out of whole cloth.
The job of the media is not to repeat rumors, but to present facts—so that the public can draw rational conclusions from empirical evidence. Today, the New York T.imes ran an Op-ed signed by Drs. Atul Gawande, Donald Berwick Elliott Fisher and Mark McClellan that does just that. http://www.nytimes.com/2009/08/13/opinion/13gawande.html?pagewanted=1&_r=1&hp The four tell the story of ten U.S. communities that have managed to do what progressives claim health care reform can do: “change how care is delivered so that it is both less expensive and more effective.” We don’t have to ration care. We don’t have to raise taxes for the middle-class or the upper-middle class. We may need modest tax hikes for the very wealthy to seed healthcare reform. But structural changes in our health care system can ultimately provide the savings needed to offer high quality, affordable care to everyone.
Last night, the Lehrer Report made the same point: http://www.pbs.org/newshour/indepth_coverage/health/healthreform/ We already know how to lift the quality of care while reducing costs. This is not a theory dreamed up by ivory-tower academic physicians. It is a fact.
On the Lehrer Report, health-care correspondent Betty Anne Bowser visited an integrated multi-specialty clinic in Billings, Montana that has managed to reduce health care spending by improving the quality and safety of care. There, 240 physicians work together, on salary, in a single system. At the center of that system: the patients who enjoys better care for less.
Opponents of health care reform say that this just can’t be done. The claim that if we reduce spending we will be forced to ration needed care. Why are they so negative? They want to see our national health care bill continue to grow because they represent those who profit from runaway health care inflation. Those who speak out against reform are not trying to protect patients—they are trying to protect the interests of our for-profit health care industry.
Meanwhile, the naysayers are denying reality. As the New York Times Op-ed points out, true reform can happen anywhere in America. Here’s the list of the ten communities that have transformed their health care systems and now boast better outcomes for less. : Asheville, N.C.; Cedar Rapids, Iowa; Everett, Wash.; La Crosse, Wis.; Portland, Me.; Richmond, Va.; Sacramento; Sayre, Pa.; Temple, Tex.; and Tallahassee, Fla., There is nothing extraordinary about these cities except for the fact that local health care providers have gotten together, and decided to do something about the waste in their system.
Physicians and hospital leaders in Cedar Rapids began by counting how many CAT scans they were doing, only to find that in just one year 52,000 scans were done in a community of 300,000 people. “I was embarrassed for us,” confides Jim Levett, a cardiac surgeon and the head of a large physician group in Cedar Rapids. It’s just not likely that 1/6 of the population needed a CAT scan in a given year. Moreover, as the Op-ed points out, “A large portion of them were almost certainly unnecessary, not to mention possibly harmful, as CAT scans have about 1,000 times as much radiation exposure as a chest X-ray.”
The stories of how these communities reformed their health care systems vary, but two common themes emerge. First, most moved away from fee-for-service, finding other ways to pay doctors. (Even those that retained some form of fee-for-service blunted the effect by pooling fees.) Secondly, collaboration replaced destructive competition. Rather than engaging in medical arms races—with each hospital in the community buying the same exorbitantly expensive and redundant equipment—hospitals competed to see who could be more efficient, eliminating unneeded hospital beds, along with unnecessary hospitalizations.
Like the clinic in Billings, these communities have demonstrated that less care is often better care. To learn more about these ten turn-around stories, listen to this NPR report http://www.npr.org/templates/story/story.php?storyId=106875583 and read this Health Affairs blog http://healthaffairs.org/blog/2009/07/28/low-cost-high-quality-care-in-america/
The Lehrer Report ends with an interview with Dartmouth’s Dr. Elliot Fisher who observes that reform doesn’t necessarily mean paying most physicians less, but it does mean “paying them differently by rewarding them for reducing the costs of care.” And it turns out that that Billings is one of 10 medical centers nationwide taking part in a Medicare demonstration project that is trying to find out if these integrated systems can manage chronically ill patients more efficiently. The answer: “yes.” Just one sign of success: they have reduced hospitalizations by 40%.
The House Bill for healthcare reform calls for more Medicare demonstration projects, like this one, that would allow Medicare to experiment with how it pays for care, and how care is delivered. Successful Medicare reforms will, in turn, create a blueprint for the public sector insurance plan that the administration plans to roll out in 2013. As HealthBeat has said from the beginning , Medicare reform will pave the way for national healthcare reform. This is one reason why it is essential that we have a public insurance option that is modeled on a reformed version of Medicare.