- Focus more attention and dollars on prevention, which costs far less than treatment, especially treatment in ERs.
- Put more attention and dollars on expanding primary care, which is a low-cost way to keep people healthy and reduce the number of higher-cost interventions.
- Create a national electronic database of medical records, which would drastically cut administrative costs while reducing medical accidents.
But that's the "easy" stuff. There can be no serious effort to cut health care costs in this country until we as a people accept that we can't have it all. We can't have an MRI machine in every clinic and we can't provide unlimited options for treatment and at the same time complain that our health care costs are too high.
Medicare paid for expensive exploratory surgery for my dying 94-year old mother that, even had it succeeded, would have given her only a few more months. Her case is hardly unique. Studies show that, overall, adding expensive high-tech options does little or nothing to improve health care outcomes.
But do I want a government bureaucrat telling me whether or not I can have a certain medical procedure? No, I do not, but even more I don't want an accountant in an insurance company making that decision. I want a doctor helping me and my family choose options. And if those options are limited, at least I want them limited by some sensible parameters created by experts who have no economic stake in the outcome.
Means testing is another difficult cost-containment option. My mother left an estate of $250,000. Her final illness cost $35,000, yet her estate paid not a dime of it. In my view, Medicare should have taken all or part of that $35,000 from her estate.
Courage. No health care reform will succeed until the White House and the Congress are finally willing to stand up to the health care lobby. The shameful hold on Congress by that industry must end; the names of legislators beholden to it must be widely publicized, so voters can assess who's listening to the money, not the needs of the people.
Government must use its enormous bargaining power to lower the costs of the health care it pays for, such as Medicare and Medicaid. It was outrageous for Congress in 2003 to forbid Medicare from negotiating lower drug costs with pharmaceutical companies.
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