The November 25 Sunday New York Times included yet another editorial bemoaning "The High Cost of Health Care." It is a good editorial, and I generally agree with both its list of Causes as well as its recommended Solutions. But I wonder if anything will come of it.
The editorial points out that "health care costs are far higher in the United States than in any other advanced nation, whether measured in total dollars spent, as a percentage of the economy, or on a per capita basis." This would be fine, or at least tolerable, if the U.S. enjoyed a quality of health care commensurate with its higher costs. But as we well know, this is not the case.
The Commonwealth Fund, a private foundation, reported in a recent article, "Despite health expenditures that are twice those of the median industrialized country, a new national scorecard of U.S. health care system performance finds the nation falls short on key indicators of health outcomes, quality, access, efficiency, and equity." It goes on to say that "Among 19 industrialized countries, the U.S. ranked 15th on mortality from conditions amenable to health care, or deaths before age 75 that are potentially preventable with timely, effective care. The U.S. rate was more than 30 percent worse than the benchmark—the top three countries. The U.S. also ranks at the bottom for healthy life expectancy and last on infant mortality."
There is nothing new here. We have all been reading editorials and reports like these for a while now. Calls for action abound. Among the top recommendations of the 2004 U.S. National Innovation Initiative was a call to build a health care test bed, including electronic health reporting, standards for an integrated health data system, pilot programs for international exchanges on health care research and delivery, and the use of performance-based purchasing agreements.
Finally, the 2005 report, A Healthy System issued by the Technology CEO Council, concluded, "If there's one thing that everyone agrees on about the U.S. health care system, it's that it isn't, in fact, a system," and that "the sad truth is that in health care today the whole is much less than the sum of its parts." The report went on to say, "We will never fix this problem simply by tinkering with its parts. As a practical matter, and as a moral imperative, we have to address the systemic problems of health care. And the most glaring - and promising - is health care's shocking lack of modern, networked information technology (IT), and the lost quality and efficiency that result."