Obamacare is only first step for reform

by Robert I. Field, Ph.D., J.D., M.P.H. 

Will we ever finish reforming health care?

Obamacare made a good start. It will save about 30 million Americans from being shut out of the system for lack of insurance. But much more needs to be done.

The prestigious Institute of Medicine issued a report this week showing what we are up against. It concluded that one-third of all medical spending in the United States is wasted on useless tests and treatments. That’s $750 billion a year in unneeded care. (Click here to read the report.)

The government pays for much of that waste through Medicare and Medicaid, which makes it a significant contributor to the federal budget deficit.

But the report contains an even more disturbing finding. It estimates that almost 75,000 people die each year from substandard and unnecessary care.

Where does all this waste and inefficiency come from? The reports identified a few major problem spots:

  • One in three hospital patients suffers harm during their stay.
  • One in five Medicare patients is re-hospitalized within 30 days.
  • One in five patients reports that test results or medical records were not transferred to their doctor in time for a medical appointment, and one in four reports that a test had to be ordered more than once.
  • Half of all adult patients report problems with care coordination, notification of test results, and communication among doctors.
  • More than half of all patients do not receive clear information on the benefits and trade-offs involved in their treatments.

The report also recommended steps to addresses these problems. They include better information systems, improved clinical decision support, enhanced continuity of care, and increased performance transparency.

The hard part is figuring out how to put these steps into effect.

A few ideas are already part of Obamacare. One is creating accountable care organizations, which are groups of providers that coordinate different levels of care. Another is to pay providers for bundles of related services rather than for each one separately. They can then figure out among themselves how to allocate payments and services most efficiently.

Neither of these is a complete solution, but they may spawn experiments that could show what works and what doesn’t. The next round of reform can then explore ways to put successful strategies into effect.

Mitt Romney has promised to repeal all of Obamacare if he is elected. That means the experiments in making care more efficient would disappear along with everything else. He has yet to say what he would propose to replace it.

At stake are a chance to save 75,000 lives a year and to substantially cut the budget deficit. An issue like that shouldn’t be ignored.