US health policy adrift

Jonathan Oberlander’s recent paper in the Journal of Health Politics, Policy and Law is titled “Throwing Darts: Americans’ Elusive Search for Health Care Cost Control.” In our search, or dart throwing, Oberlander wonders why we seem so ignorant of both our past and of the rest of the developed world.

The American debate has lost sight of a crucial fact: it is not just about how you pay for medical care, but how much you pay for services. Rather than emulating policies that actually work to constrain spending abroad (e.g., global budgets, fee schedules) the United States seems intent on reinventing and reorganizing its way out of the cost crisis. Yesterday’s conviction that capitation and integrated delivery systems held the key to stemming medical costs has been resurrected in the current fad for accountable care organizations and bundling, with scant acknowledgment that we have been down this road before. An ever-increasing list of abbreviations (HMOs, HSAs, HIT, P4P, and so on) bear witness to Americans’ elusive, and now four-decade- long, search for magic bullets. […]

[I]nternational experience suggests that other nations do know how to slow medical spending; the United States is simply unable or unwilling to adopt those policies. Americans are, in other words, determined to try all available cost-control options — except those that actually succeed elsewhere. Ultimately, the insistence that the United States has to try everything because nothing is certain to contain medical costs sounds less like agnosticism or intellectual curiosity and more like ignorance.

It’s worth asking, are we moving toward something at the intersection of “uniquely American” and sustainable? Or are we just wandering around, willfully ignoring what we should have learned by now and that others overseas seem to have grasped? I mean, seriously, if you’ve tried fixing the pipe for a week or two and water is still spilling over the floor, wrecking the hard wood, isn’t it rational to consider putting down the wrench and calling in a plumber who knows what the hell he’s doing?

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