Physicians the key to affordable health care

Last week in this column an article on health care costs that ran in the June 1 edition of The New Yorker was reviewed. The story by Dr. Atul Gawande has become must-reading in the White House. President Barack Obama believes it points the way to massive savings in spending on Medicare; savings that can be used to extend health care coverage to today’s uninsured and to reduce the cost of health care to all Americans.
The nut of Gawande’s research was that high-cost medical centers get that way because physicians over-treat patients, ordering expensive tests and courses of treatment that do not yield better health results. His conclusions echoed studies made by researchers at Dartmouth College.
Some look at these findings and conclude that health care costs can be reined in by capping Medicare payments to providers at the level established by the lower cost health care centers. The logic goes this way: If the Mayo Clinic in Rochester, Minn., can provide seniors the best health care available anywhere in the world for less than $7,000 a year, which it does, then any health care center should be able to operate at or under that level of funding.
But Mayo’s Medicare costs are in the lower 15 percent in the country. Using them as a capping point would have draconian results and would turn the nation’s providers into fierce opponents of reform.
The challenge is to enlist providers — physicians primarily — in the search for better ways to provide health care at an affordable cost.
Doctors are the key. They decide whether patients are treated in the office or in a hospital; they decide what testing should be done and how often; they prescribe the drugs, etc., etc., etc. If the nation’s physicians can be persuaded that bringing the cost of health care in the U.S. from 16 percent of the GDP to 11 percent of GDP — which would still leave us the most expensive in the world — is a critically important national goal to achieve, it could be reached with a minimum of conflict and disruption.
Getting that job acomplished will be the toughest test the new president will face.

— Emerson Lynn, jr.