Thursday, February 5, 2009

How can we afford NOT to spend money to make health care more effective?

A Washington Post editorial today criticizes President Obama for seeking a stimulus package that is (in the President's own words) "not merely a prescription for short-term spending" but a "strategy for long-term economic growth in areas like renewable energy and health care and education." This, the Post says, is "precisely the problem" and "even potentially meritorious items, such as ... billions more to computerize medical records, do not belong in legislation whose reason for being is to give U.S. economic growth a 'jolt.'"

The Post was writing about an opinion piece by President Obama, in which he takes on "misguided critics" of his plan who say that "we can ignore fundamental challenges such as energy independence and the high cost of health care and still expect our economy and our country to thrive." Instead, the President says, "Now is the time to protect health insurance for the more than 8 million Americans at risk of losing their coverage and to computerize the health-care records of every American within five years, saving billions of dollars and countless lives in the process."

As I write this, a group of U.S. Senators is working to strike from the stimulus bill funding for a variety of programs that, in their view, will not provide immediate help to the economy.

Let's think about this. Health care costs are, in the words of the Congressional Budget Office (CBO), the "greatest fiscal challenge" facing the United States.

Spending money on health IT will likely produce jobs in the short-term (someone has to design, sell, install, update, maintain the systems, and provide support to practices on implementation and use). But the benefits of spending money on health IT can't just be measured by the numbers of jobs produced. Health IT has the potential to lower health care expenses by billions of dollars, reduce medical errors, and improve quality (CBO).

Other programs in the stimulus bill, like funding for comparative effectiveness research and training more primary care physicians, can bring enormous benefit to the economy by creating the infrastructure needed to improve health care outcomes and reduce the costs of care. Yet they are also vulnerable to being struck.

On this issue, the president has it right, and his critics, wrong. In a letter sent this afternoon to all U.S. Senators, ACP urged that programs to fund health IT, comparative effectiveness research, and primary care be kept in the bill.

Today's question: If you had $800 billion to spend, would you spend it: (1) only on programs that may create jobs in the short-term, but may produce little long-term economic gain for the economy or (2) programs that can create jobs now and help the economy over the longer haul by lowering health care costs?


Jay Larson MD said...

Programs that can create jobs now and help the economy over the longer haul by lowering health care costs.

Health care is 16% of the GDP. As health care costs rise and the GDP decreases with the recession, the percent of GDP consumed by health care will increase even more. Any effort to bend the health care cost curve is worth the investment.

Steve Lucas said...

Or 3) That money be set aside, and after careful study, be spent on creating a better medical climate in the US.

Simply throwing money at medicine will not solve its problems. That is the current problem, we will pay for anything based on the false assumption something good will result. In the case of IT we have seen massive failures in the UK, why repeat this?

In the case of effectiveness, we need real studies, not run by pharma, that will lead to real winners and losers that will then be implemented as best practices.

We do not need to raise the income of all doctors across the board. We need to design a compensation system that rewards the true medical practice of meeting patients needs, not checking boxes with test and procedures.

Throwing people's hard earned money at this problem, with no concrete results, will only create more resentment against the medical community. Bringing mandated IT, or other products, into the small medical practice will only create an economic crises that many will not survive.

Steve Lucas

Clifford Dacso, MD said...

My view is that the issue is couched in such a way as to make it sound inherently like a boondoggle for EMR companies that have not successfully made a product that answers the needs of physicians, payers, and most importantly, patients. The consumer of health care does not see how the expenditure of several B will improve his or her diabetes or hypertension. And I agree. The conventional EMR improves patient care in the aggregate but it can do so much more. If the EMR initiative is construed as bringing health care into the home and allowing people to make informed judgments about their own health and the health of their families, I believe that it will gain traction. If it is merely turning my paper chart into a pdf...forget it.

Unknown said...

Jay Larson has it right. Health care costs are the issue. Just as health care costs have crippled the auto industry, health care costs will severely limit the government's ability to fund other priorities such as education, defence, and long term infrastructure. The "stimulus package" helps a bit with support for cost effective primary care and clinical effectivenss research, but little else to rein in health care costs. HIT has yet to be shown to save significant $, even though quality can increase. Even if the health provisions of the package are effective, they are a tiny sliver of the $900 billion bill. Better idea--give every family in the US $75,000 tax free to spend as they wish and it would be cheaper, highly stimulative to the economy, and still would leave money left over for the health provisions!

The Happy Hospitalist said...

I would give it to the people for them to spend. They spend money much more efficiently than government does