National experts addressed the most pressing political issues in health care at the Oct. 7 “Health Care Challenges Facing the Nation” conference at the Washington University Medical Center. Prominent among the bevy of hot topics were discussions about limiting access to health care to help alleviate rapidly escalating health care costs. Read more in the following St. Louis Post-Dispatch article by Rachel Melcer.
U.S. must limit access to health care, experts say
(Republished with permission from the St. Louis Post-Dispatch. This article originally ran in the Business section on Friday, October 8, 2004)
By Rachel Melcer
Of the Post-Dispatch
The United States must limit access to health care to curb drastically escalating costs, two renowned policy experts said Thursday during a conference on health issues at Washington University.
But they differed sharply on whether that would lead to a medicine bottle half-empty or half-full.
Henry J. Aaron painted a bleak picture of patients doing without care and doctors desperately rationalizing the situation to cope. Yet, Gail Wilensky essentially said that a little rationing – done the right way and for correct reasons – would not be a bad thing.
Both have worked for the federal government, though on opposite sides of the political aisle.
Aaron, a senior fellow at the Brookings Institution, had been assistant secretary for planning and evaluation in the former Health, Education and Welfare Department. He also chaired a Social Security advisory council during the Carter administration. Wilensky, a senior fellow at health-education foundation Project HOPE, was deputy assistant for policy development to President George H.W. Bush and has administered the Medicare and Medicaid programs.
Aaron sees the future in health care as “an extremely formidable challenge” to the economy.
If medical spending continues to rise each year by 2 percentage points more than personal income, then by 2040 Medicare and Medicaid spending would hit 18.5 percent of the gross domestic product, up from 4.2 percent in 2004, and the federal deficit would be 20.7 percent of GDP, up from 4 percent today, he said.
Even if the rate of increases in health-care spending drops to 1 percent greater than income, Medicare and Medicaid would be 11.2 percent of GDP and the deficit 13.3 percent, he said.
“The health care bill is going to be fearsomely large,” Aaron warned. “The nation is going to have to choose between dramatically higher taxes, shredding the social safety net and … health-care rationing.”
Wilensky, however, predicted the United States will not dramatically ration care, leaving out the elderly and bypassing preventive care, as Aaron suggested.
“Other countries do it. It’s not that we literally can’t, it’s that we won’t,” she said, citing political realities and the nation’s character as standing in the way.
Instead, the health care industry and government must institute standards, testing and incentives to squeeze waste and inefficiency from the system, she said. That should be the basis for cutting back.
The industry and government must take advantage of information technology and data collection to make rational decisions on what care is worth, she said. For example, expensive new drugs or treatments should be tested against current protocols to ensure that there is an added benefit before they are approved for use and reimbursement.
In that way, the annual rate of health care spending increases can be brought down to between even and 1 percent above growth in GDP, Wilensky said.
“It’s a long leap from where we are right now to where I think we need to be,” she said. But there is growing awareness of problems in the medical system.
Despite top-dollar spending on care, recent studies show that medical mistakes – some resulting in deaths – are more common than they should be, Wilensky said. Health care still is a “cottage industry,” she said, lacking national standards and protocols, even though it is a huge sector of the economy.
Physicians make some treatment decisions based on fear of lawsuits, for example ordering tests as a defensive measure, rather than for value, Wilensky said. Such practices must be stopped, and if the private sector begins to change, then government programs eventually will follow.
Aaron did not propose a solution, other than possibly raising taxes and refusing to ration care – but he doubted that would happen in the “tax-phobic” United States.
As a nation, “We have not yet begun to think about these issues,” he said. “It’s important that we start now.”
Reporter Rachel Melcer
E-mail: rmelcer@post-dispatch.com
Phone: 314-340-8394
Copyright 2004 St. Louis Post-Dispatch, Inc.