Only a 'health care Fed' can trim costs

Jonathan Weiner, professor of health policy at the Johns Hopkins Bloomberg School of Public Health

TEXT OF COMMENTARY

Kai Ryssdal: As we mentioned to start with today, President Obama spent some time at his press conference this morning talking about health care. Why he thinks some kind of public insurance plan has to be part of any overhaul. And how he's determined not to add substantially to the budget deficit to get reform done. Commentator Jonathan Weiner says there's really only one way to trim the fat.


JONATHAN WEINER: For decades health-care inflation has outstripped economic growth by 3 to 1. The main reason for these sky-rocketing costs? Medical technology.

A $100,000 biotech drug for cancer, a $600 MRI for tennis elbow, or a $3 purple-pill for whatever. It all adds up.

Today, deciding what's "medically necessary" is a rather haphazard business controlled by insurance companies. They try to make the right decisions. But the process is very flawed and often centers on the conflict between payer or provider profits, rather than on patient welfare.

So who should decide what care is, or isn't covered?

What we need is a "health-care Fed": A panel of independent experts, consumers and ethicists who would make these tough decisions based on scientific evidence about what works, and what doesn't.

Technologies that are real advances would go on the "A list" and be covered in full. "Me-too" drugs or devices with modest benefit for patients would only get partial coverage. And forget about treatments with unsubstantiated efficacy.

You'd be shocked by how little the medical community knows about which interventions really work. A health-care Fed would set national priorities for medical effectiveness research.

You may balk at more government oversight. But would you rather have your employer or the medical corporations decide?

Or maybe we should just leave your family doc alone to prescribe as she or he sees fit. But it's utterly impossible for them to handle all of this information on their own.

How do we know a health care Fed can work? Because every other industrialized nation in the world has something just like it: The Brits have one, as do the Canadians and Australians. That's why their costs are lower and patient outcomes better.

It's great that they're exploring private and public options on Capitol Hill. And its even better yet that the medical-industry has pledged to play nice. But reform of any kind will fail unless we find a rational and ethical way to eliminate the endemic of ineffective care.

RYSSDAL: Jonathan Weiner is a Professor of Health Policy at the Johns Hopkins Bloomberg School of Public Health in Baltimore.

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