The Other Half of Healthcare

The debate surrounding healthcare in the past few years has focussed on ‘Obamacare,’ i.e., the Patient Protection and Affordable Care Act.  In its most basic essence, that piece of legislation was composed of two parts: insurance industry reform and expanding coverage.  I’m not going to bother with a full throated defense of the act, as everyone has their own opinions on it, and in my ever-s0-humble opinion, the law was a carefully considered and balanced piece of legislation that took into account both Democratic and Republican ideals that had long been espoused by members of both parties, but one that Republicans walked away from for a variety of political reasons.

Since the Supreme Court ruling this summer that upheld the law, the debate is settled, and it will proceed to be implemented, in varying degrees, depending on how state governments comply with the provisions set forth by the bill.  So now that those provisions will take effect, it’s going to only solve one side of the equation.  The entire issue of healthcare was broken into a few parts, in order to make it easier to move forward.  Meaning, once you finish one part, in this case, insurance reform and coverage, the next logical step will be how to best manage costs and outcomes.  This was an intentional political gambit that Democrats opted to make.  The reason being that once you pass the first part, the second part would be easier to manage.

So, now, onto costs and outcomes.  Where exactly is it that America finds itself on these metrics?  Not to mince words, pretty piss poor by any reasonable standard.  We spend more than any other country on a system and get mediocre results, particularly when you measure that relative to what we’re paying for.  A report out Thursday by the nonpartisan Institute of Medicine, a federally mandated body that is comprised of medical delivery experts that operates under the auspices of the National Academy of Sciences, found that our medical system annually wastes approximately $750 billion.

That’s a lot.  It’s 30 cents of every dollar that we spend on healthcare.  While that figure is going to initially prompt shock, it’s actually a cause for hope.  Here’s why: once we reform the way that we deliver healthcare to the American public, this figure is something that we can either reduce from governmental expenditures, or hold level to even further boost the health of Americans.  It’s a figure that we can use to hold steady what we’re spending, squeezing better results out of the margins, while holding costs constant and delivering ever better outcomes.

Americans have always had a propensity to equate problem solving with spending more money.  Frankly, it’s the easy solution.  The problem is, it’s becoming ever clearer that it’s not the correct policy prescription.  The way in which we spend the money in order to achieve an outcome is more important than the actual dollar amount we shell out.  And while this amount is certainly jaw-dropping, it’s one upon which we can build in order to not only hold costs down in the future, but also to make all of us healthier.  Talk about a silver lining.


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