The ACA is fundamentally insurance reform, and that effectively limits the federal government’s healthcare reform initiatives to reduce spending to Medicare and, to a lesser degree, Medicaid.
The spending problem is not what primary-care physicians cost, which CMS says is about 5 percent of their outflow, but what they must do to care for older patients, which impacts the other 95 percent. And, the progenitor of CMS’ spending problem begins well before they have any control — the failure to focus resources to effectively manage the epidemic of chronic disease in the rest of the population.
The problem is entropy. Chronic conditions progress in severity and complexity with time. That means that by the time chronic disease sufferers reach Medicare age, their conditions have reached a much more severe, and expensive, stage, the primary contributor to the burden to taxpayers. But, that’s just the dollars. Chronic diseases are responsible for seven of every ten deaths, or 1.7 million annually, according to the Centers for Disease Control and Prevention (CDC); enough to completely wipe out Washington, D.C., Vermont and virtually all of Wyoming.
Properly managed, the progression can be stalled and even reversed, but that process needs to be started as early as childhood for some, and in middle age for most.
That puts the primary burden of responsibility on private insurers who, like CMS, work to control the cost to treat symptoms instead of investing in managing the disease, or even better, preventing it.
This short-term, instant-savings policy is not only short sighted, it subverts the goal of reducing health care spend while reversing our declining general health, productive population and quality of life.
That is where the ACA stops short of the finish line, and, if not taken there, why it may be doomed to become yet another bloated cash sink that undermines our economy while piling more debt upon our children whose future prosperity is, for the first time in American history, likely to decline from the generation before it.
The solution is not to provide less care, but the right care at the right time at the right cost. Some statistics indicate that American physicians don’t order more hospitalizations, procedures, diagnostics, or pills than their socialized medicine counterparts, but that it costs twice as much.
Costs can be managed, but the underlying problems must be addressed now, and addressed aggressively with programs and investment to effectively manage the declining health status of populations by:
• Providing incentives and financial support to enhance EHR programs to provide actionable information to properly coordinate care;
• Investing in patient education programs to tackle medical illiteracy;
• Finding ways to inject price transparency and price competition into the local healthcare marketplace;
• Properly reimbursing for behavioral modification programs to stall or reverse the progression of chronic conditions;
• Investing in “best value, best outcome” referral and procedure standards and technology;
• Rewarding those who eliminate waste and duplication;
• Removing limits on gain-sharing programs and encourage progression to provider-risk assumption to provide appropriate incentives; and,
• Enabling and preserving physician independence to eliminate bias in the system.
Tobacco kills about 595,000, or 46 times more people than firearm homicides every year in this country, and, yet, today’s national conversation is consumed in a debate on restricting firearms.
Abraham Lincoln framed the bedrock of this country in only eleven words of his Gettysburg Address: “Government of the people, by the people, and for the people.” He didn’t have to say that those precepts are focused and driven by leaders, because he was the embodiment of a leader who understood the real issue of his time; one with a vision that makes us a better people to this day.
Show the way, and a national leader will pick up the banner and drive it to a conclusion that will enrich us all for generations to come. Until then, leadership must begin with us, and be sustained by example.
Dr. Bonvicino is a former regional medical director at the Garden State Medical Group and former senior medical director of Horizon Healthcare Innovations and Blue Cross/Blue Shield of New Jersey.