From What We Talk about When We Talk about Health Care Costs, by Peter J. Neumann:
The problem is that no one in charge seems willing to acknowledge that getting a handle on cost growth will also involve uncomfortable trade-offs. We cannot as a society provide patients with unlimited access and unlimited choice. Providing better-quality care, though it is vital, won’t change that reality.
The language of the Affordable Care Act highlights the dilemma. The law states, for example, that the newly created Independent Payment Advisory Board, established to recommend spending reductions for Medicare, cannot change benefits, shift costs to patients, or ration care. The law created a Patient-Centered Outcomes Research Institute (PCORI) to conduct comparative-effectiveness research but specifies that the secretary of health and human services cannot use it as the sole basis for denying coverage for items or services. The Affordable Care Act forbids the PCORI and the Department of Health and Human Services from using cost-effectiveness thresholds. […]
However, changing the conversation to emphasize patients and stakeholders also has unhelpful consequences that few are willing to acknowledge. Focusing on patients’ own preferences to the exclusion of considerations of societal resources will only compound our cost problems. Engaging stakeholders is undoubtedly important, but one person’s stakeholder is another person’s interest group. Moreover, the only stakeholders seemingly not at the table are future taxpayers (our children and grandchildren).
One way our discomfort with the dilemmas manifests itself is that we find sufficient fault with every possible approach to addressing them so we’re paralyzed. This status quo bias is tantamount to asserting that what we have is the best we can do. We all know that’s false. Would it really be so bad to try something new, as bad as the critics claim? Is that plausible?
* I am sometimes viewed as a critic, even when I’m actually not.
AF
