I was talking with some of my more conservative friends over the past weekend among the New Year festivities and they kept coming back to this same talking point – sure, premium subsidies in the health reform bills will lower what people will pay for health care, but reform doesn’t do anything to lower the overall problem of cost growth in health care. For that we need to “tear down the system” or “start over” or “charge for obesity,” and so on. I’m thankful that we are finally at a place where almost everyone agrees costs are increasing too fast and change in needed (something we’ve been talking about for years here at the Health Access Coalition) but there’s a basic premise here that needs debunking to effectively rebut these sorts of arguments.
What many people don’t realize is that we are already delivering world-class health care at lower costs in many parts of the country. And it’s not just talked-about integrated systems like Intermountain Health Care or the Cleveland Clinic. There is huge cross-country and cross-state variation in how much we pay for delivering the same health outcomes. For example, Duke University Hospital is delivering great health care at nearly half the cost  of the most expensive health systems in the country. There’s a variety of reasons for this including physician culture, the effect of state laws on the overbuilding of medical facilities, and an organizational focus on delivering better care rather than just more care.
So, no need to tear the system down to control costs. If we just deliver care nationwide more like Duke Hospital delivers care, we solve our cost problems. And Duke isn’t even one of the most cost-efficient systems in the country. Americans already have the solution to get health costs under control – we just have to figure out how to replicate it in more places. And that’s exactly what the health care reform bills set us on the road to doing. They use pilot projects to test out different ways of paying doctors and hospitals to encourage just the sort of efficiencies and world-class reputation that Duke enjoys. And they also set up systems to bring more and better evidence of what works in health care – and what doesn’t – so doctors can figure out which is the best care for their patients.
Health reform is shaping up to be a uniquely American effort where a combination of public and private initiatives attempt to rein in the worst inequities in our current system while preserving the innovation that makes places like UNC Hospital and Duke Hospital international health care leaders. Reform may not be perfect or simple or the final answer for everyone but it is the change we need.