Given the current political climate, I doubt Congress will be forging a bipartisan deal on healthcare any time soon. It was not always thus. There was a time of hope, when some Democrats and Republicans thought they actually belonged to the same species and could work together on many of the pressing problems plaguing the nation. That was 2012. Of course, their efforts all went to hell, because the hope was just too fragile before the partisan forces already gathering at the gates.
But it was a fruitful hope that generated much research, analysis, and wonky policy prescriptions. When the current darkness lifts and partisan animosity is softened by the spirit of collective problem-solving, we could do worse than return to the ancient texts for understanding and advice.
One such text is What is Driving U.S. Health Care Spending: America's Unsustainable Health Care Cost Growth by the Bipartisan Policy Center (BPC), a non-profit organization founded by former Senate Majority Leaders Howard Baker, Tom Daschle, Bob Dole and George Mitchell – two Republicans and two Democrats. The BPC describes its mission as “principled solutions through rigorous analysis, reasoned negotiation and respectful dialogue”. How quaint – and yet my eyes mist over.
The authors of this publication explore factors that are driving the insane growth of healthcare spending in the US. Here's a list:
- Fee-for-service reimbursement;
- Fragmentation in care delivery;
- Administrative burden on providers, payers and patients;
- Population aging, rising rates of chronic disease and co-morbidities, as well as lifestyle factors and personal health choices;
- Advances in medical technology;
- Tax treatment of health insurance;
- Insurance benefit design;
- Lack of transparency about cost and quality, compounded by limited data, to inform consumer choice;
- Cultural biases that influence care utilization;
- Changing trends in health care market consolidation and competition for providers and insurers;
- High unit prices of medical services;
- The health care legal and regulatory environment, including current medical malpractice and fraud and abuse laws; and
- Structure and supply of the health professional workforce, including scope of practice restrictions, trends in clinical specialization, and patient access to providers.
The full text is available online at the link below.
Next: Addressing the drivers of healthcare spending, one by one, slowly, over several posts.
Reference:
Ginsburg P, Hughes M, Adler L, Burke S, Hoagland G W, Jennings C, and Lieberman S What is Driving U.S. Health Care Spending: America's Unsustainable Health Care Cost Growth Bipartisan Policy Center; September 2012 https://www.rwjf.org/en/library/research/2012/09/what-is-driving-u-s--health-care-spending.html