Interesting article in yesterday’s New York Times on the Washington State Health Technology Assessment Committee. This committee makes decisions about what is (and is not) covered for state employees, the Medicaid program and worker’s compensation in Washington state. The primary goals of the committee according to its website are to make:
- Health care safer by relying on scientific evidence and a committee of practicing clinicians
- Coverage decisions of state agencies more consistent
- State purchased health care more cost effective by paying for medical tools and procedures that are proven to work
- Coverage decision process more open and inclusive by sharing information, holding public meetings, and publishing decision criteria and outcomes
Who could be against safety, consistency, effectiveness, no longer paying for things that don’t work and doing all this in a more inclusive and public manner than is now done? In short, everybody! Patients, providers, critics of the Affordable Care Act who say it is a harbinger of things to come, etc. I have given numerous talks around North Carolina and the country about health care costs and health care reform to groups of providers and the public. The talks tend to go something like this.
- I describe how our health care system is unsustainable
- The audience nods vigorously and says things like ‘we must stop this out of control health spending!’
- I describe several possibilities for how we might address costs (a board like the one noted above; reform the tax preference of employer paid insurance; change methods of reimbursement, etc.)
- Lo and behold, the audiences hate all of the possibilities!
If we ever slow per capita health care costs as compared to what they will be with no change it will mean that less care is provided, and/or providers are paid less for that care. Even if a ‘market based’ solution were achieved, cost savings would mean less care and/or less payment per unit of care. Any savings achieved by any means will be a reduction in someone’s income compared to what it would have been with no change, and our culture strongly assumes more care is better. The hardest part of slowing health care costs is cultural, not technical.
