The health care debate

Rochester’s Mayo Clinic is getting plenty of attention as the health care debate has eclipsed the economy as the number one domestic issue.

President Obama holds a news conference tonight (7 p.m. CT with live-blogging here) to try to win support for his proposals, amid growing punditry that his entire presidency is on the line.

Mayo Clinic, and particularly its CEO Denis Cortese, doesn’t like the president’s proposals. In a story on National Public Radio on Tuesday’s All Things Considered, it was described as “one of the health-care industry’s great bargains, with costs 28 percent below the national average.”

So when Mayo speaks, people in high places tend to listen. Here’s the clinic’s blog speaking:

“The proposed legislation misses the opportunity to help create higher-quality, more affordable health care for patients. In fact, it will do the opposite.”

… and …

“Unless legislators create payment systems that pay for good patient results at reasonable costs, the promise of transformation in American health care will wither. The real losers will be the citizens of the United States.”

Dr. Cortese told NPR further that “by higher value, we mean better outcomes, better results, better safety, better service — at lower cost over time.”

How to do that isn’t exactly spelled out. But in a response to a New York Times blog post on how much health care really costs ($15,000 a year per family), a Mayo physician, Randall Walker, offered his idea.

It’s a lengthy comment that deserves a full reading (several times, in my case. Such is the nature of the health care debate).

The government simply needs to do what it has always done best: to obtain money from those who have more to help those who have less.

The key is to structure this within a frame-work that nonetheless gives everyone, across all levels of income and employment conditions, more first-dollar responsibility for health care expenses, with the opportunity that comes with it to directly retain the savings of their wiser health care choices.

Dr. Walker says later in life, health savings accounts could be tax-free gifts to heirs…

In this way, many consumers would forgo a lot of the futile, expensive medical interventions toward the end of life that do not significantly improve the quality or duration of one’s life — knowing they and their heirs can directly enjoy the financial benefits of these choices.

It all starts, quite simply, with comprehensive means-adjustment — for both the below-deductible payments to providers and the premiums to insurers that consumers would pay in relatively high-deductible / low-premium insurance policies.

At the heart of much of the health care debate, it seems to me, is the notion that people are simply wasting the health industry’s time by seeking treatment without regard for its true cost. Perhaps, but is that what you”re seeing at the end of the health care food chain?

I don’t dismiss the logic, but I also don’t see how it meets the intent to raise the quality of care. There are plenty of stories about people who die of heart attacks because they didn’t choose to go to the ER when the chest got tight.

The other day, a family member told me the story about getting hit in the head during an athletic contest. His head hurt and his vision was blurry and common sense dictated a trip to the doctor was in order. But he didn’t go because he knew a CT-scan would be prescribed and those cost too much.

I fell off a roof last year and didn’t go to the doctor for exactly the same reason. That might make financial sense, but it doesn’t make medical sense.

And that’s the issue that’s making everyone’s head hurt in the health care debate. How can a system do both?

Writing on the Health Care Blog, Matthew Holt suggests the question doesn’t matter, because the legislation being considered doesn’t do either.

Of course we’ll be back here in a few years because the fundamental problems of the health care system–employment-based insurance & fee-for-service medicine–will remain whatever happens this summer. And they continue to be a recipe for disaster. Although of course it’s a disaster that has lots of supporters.

It’s almost enough to make you tune out and turn on Fox. Almost.