Monday, July 14, 2014
The New York Times
July 14, 2014
Why Improving Access to Health Care Does Not Save Money
By Aaron E. Carroll
One of the most important facts about health care overhaul, and one that
is often overlooked, is that all changes to the health care system
involve trade-offs among access, quality and cost. You can improve one
of these – maybe two – but it will almost always result in some other
aspect getting worse.
You can make the health care system achieve better outcomes. But that
will usually cost more or require some change in access. You can make it
cheaper, but access or quality may take a hit. And you can expand
access, but that will increase cost or result in some change in quality.
More people being able to get care was the point of the A.C.A. It's
possible that overall health care spending may remain flat or even
decrease because of other changes to the health care system, or economic
factors outside the system entirely. But with respect to emergency care,
prevention and procedures, we should expect that increasing access will
lead to more spending, not less.
It's understandable that supporters of the law want it to increase
access, increase quality and decrease spending all at the same time, but
that's very unlikely. Trade-offs occur; we need to be honest, and
prepared, for what's likely to happen.
San Juan Capistrano, CA
The supposedly inevitable trade-offs between access, quality and cost
ignore one important intervention regarding cost. The health care
financing system in the United States is unique in its profound, costly
administrative waste due to the highly inefficient, fragmented financing
through a multitude private insurers and public programs (and no
programs at all for the uninsured).
Merely changing to a universal single payer program or a national health
service model dramatically reduces costs without having a negative
impact on access and quality. The future trajectory of cost increases
would be shifted downward - achieving that elusive bending of the cost
curve. That is one way other nations provide truly universal health care
at a per capita cost averaging only half of that of the United States.
In fact, the monopsonistic purchasing of a public program can actually
improve quality by obtaining greater value in health care purchasing.
Some of the savings that would accrue by changing to a universal program
such as an improved Medicare for all would be redirected to much needed
improvements in access.
The important bottom line is that we really can achieve improved access,
improved quality, and lower costs by structural reform of our highly
dysfunctional financing system - a system that was only expanded by the
Affordable Care Act.
This author makes a compelling case that the ACA will not decrease costs
because there are trade-offs among access, quality and cost. What he
ignores is that we also have another system, Medicare, operating
simultaneously, that provides good access and quality and manages to
limit cost with little trade-off. In addition, it serves the population
that consumes the greatest share of health care. You, good reader, know
the difference. This article shows, once more, why we need a single
payer system for all.
at 1:20 PM