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03/11/2014 Obesity in Michigan: What Can We Do?
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Editor's Note: This column previously appeared in Bridge Magazine.
Great news! The latest and greatest approaches to reducing health care spending are here: paying primary care doctors more, bundling payments for doctors and hospitals; sharing savings and investing more in systems that integrate care. Hooray! New answers to the cost curve dilemma!
Steven Brill’s article on health care costs in the March 4 issue of Time magazine is the talk of the town in health care. While journalists have generally praised the piece, reactions from those in health care have been mixed. The American Hospital Association critiqued a number of Brill’s major points in a fact sheet, Setting the Record Straight on TIME’s Article “Bitter Pill.”
On February 5, 2013, Congressional Budget Office (CBO) director Douglas Elmendorf testified before Congress on the CBO’s budget outlook for 2013-2023. As reported in the New York Times and elsewhere, the health care outlook was remarkable: projected Medicare and Medicaid spending for 2020 was down 15 percent over projections made three years ago.
Why does health care cost so much more in America than in any other country in the world? One major reason is that our system is really a non-system. That is, in America we have many different payers, financing mechanisms, benefit designs, and structures. Every health plan has its own ways of doing things, and every health purchaser wants a customized benefit plan that meets its own specific goals.
Medicare is a sensitive political topic. Today's seniors are understandably protective of their benefits, and future seniors are worried those benefits won’t be there when they become eligible (whether the eligibility age is increased or not).
In many respects, the Affordable Care Act is a law about health care coverage. It is designed to expand coverage, mostly by using two tools: (1) the requirement for individuals to have/purchase health coverage or face tax penalties (known as the individual mandate), and (2) the expansion of Medicaid eligibility to all with incomes at or below 138 percent of poverty.
While many have criticized the Obama administration’s communication about the benefits of the ACA (and justifiably so), few have focused on the role of the press.
In a New York Times op-ed last December, Elizabeth Bradley and Lauren Taylor wrote about the study of global health spending published they published in the journal BMJ Quality and Safety. Their analysis broadened the concept of international health care spending to include spending on social services.
In 2010, when we published our study on healthcare variation in Michigan, we were able to show considerable geographic variation around the state of Michigan on a variety of procedures and services. We intentionally chose services where the research indicated either a tendency toward over-utilization (relative to evidence-based guidelines) or where the guidelines were unclear.