Chasing the Rabbit: Official Blog by Author Steven Spear

Jonathan Gruber (NY Times Op Ed Medicine for the Job Market Dec. 4 08) may be right that healthcare reform will be economically good, but his assertion that we need to spend more to get more is based on the assumption that the care we currently receive is limited by the investments we make. This premise is wrong. The problem is not too few resources available to meet overwhelming needs. Rather, it is that those resources are managed in such an antiquated fashion that 1/3 to 1/2 are regularly squandered at great human and financial cost.

This is avoidable. Hospitals associated with the Institute for Healthcare Improvements 100K Lives Saved campaign, the Pittsburgh Regional Healthcare Initiative, and other efforts have pioneered more sophisticated approaches to managing care delivery with incomparable results: A complete elimination of events that have enormous human and financial cost, the spending on which compromise and deny care to others, coupled with increased access to primary, chronic, and acute care of better quality. 

We do not need to spend more. Rather, we need to reward those who are getting better and provide incentive to others to do the same so what we invest is better spent. First, the federal government is uniquely able insist that performance be measured: both of treatments for various conditions and also on how well those treatments are carried out. This will be a huge benefit to payers and patients who, right now, are severely compromised in determining where they should look for care and if they are being treated as well as possible. Second, the federal government should make choices of where to access care based on those measurements, setting a powerful example for states and the private sector to do the same. The resultant shift in resources from those who use them badly to those who use them well will mean far better care for many more people–meaning poor access and poor care won’t be drains on society, and care will be provided at less cost—meaning that wealth will be available for other important uses.