Healthcare Reform Means Taking "No" for an Answer
Saying yes to every new drug, device, or test doesn't necessarily lead to better health
Jessie Gruman is president of the Center for the Advancement of Health.
Something's gotta give in healthcare. As individuals, we can't just go on saying "yes" to every drug, device, test, or intervention that might work. And as a nation, we can't just allow our health bill to continue to climb, bankrupting sick patients and our economy.
The Obama administration promised healthcare reform and all the interest groups—health professionals, drug and device manufacturers, hospitals, the insurance industry, and patient advocates—are at the table. There is broad agreement that something has to change. And change probably requires saying "no" to some things.
Discussions of reform have begun to encounter resistance: While everyone agrees that limits must be set, each party thinks it's the others who should be reined in.
The public is no different. Rather than thinking that reform means increasing limits, we think of it as increasing opportunities: easier access to affordable healthcare services and doctors we can trust to make good use of the best tests and drugs and devices to keep us free of pain and fully engaged in our lives. Far too few of us realize that less care is often better care and we are thus understandably reluctant to say "no" to recommended tests or procedures of limited value.
Reformers and policy experts interested in reducing costs and improving care have some ideas about what we should say "no" to: treatments that have not been shown to work, doctors who err, and hospitals with poor safety records. "No" to expensive new tests and drugs that are no more effective than older, cheaper ones. "No" to extra tests and services that won't improve our health and the quality of our lives.
But a recent Kaiser Family Foundation poll demonstrates that whether the public will agree to "just say no" depends upon who asks.
It found, for example, that we trust our doctor to tell us what tests and treatments we need, but not our health plan or the government. We don't think there is a significant difference in competence among the doctors who treat us and we are more likely to rely on the experience of friends and family over objective ratings of doctors and hospitals. We're convinced that under-use (caused by penny-pinching health plans) is a bigger problem than the overuse of services. And we believe we are already paying too much for care, which we think is costly due to the excessive profits of insurance and drug companies.
Current reform proposals call for everyone—health plans, drug and device manufacturers, physicians, nurses, hospitals, and yes, the public, sick and well—to recognize and accept new limitations.
And so, alas, healthcare reform is about "no," even for us.
As voters, we will determine the success or defeat of this year's reform efforts. But let's not kid ourselves: Our choice is not between unlimited access to all the healthcare we think we need and draconian government intervention. Rather, we either learn to accept explicit, evidence-based limitations in plans, providers, and treatments, or we continue to accept limitations to care based on de facto rationing of access (growing numbers of uninsured, under-insured, and medically inspired bankruptcy) and treatment (increasingly constrained benefits packages that restrict what treatments they will cover)—accompanied by steadily increasing costs.
We have to say "no" to one of these options. Something's gotta give. Which "no" is it going to be?
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Reader Comments
Just tell us what it is going to cost....
I think most people would be more rational about accepting health care changes if a clear cost/benefit was laid out instead of all the political manipulations and attempts to make bad look good and good bad. Just be honest and tell us how much we are going to have to pay for it!
A Concerned Citizen
"Why should they worry if we get sick? They don't pay the bill. We do - and sometimes we get destitute in doing so, and some of us die. Not their problem."-Joan
Your talking about the food industry, but what about our federal government? They are not paying for this system either, we are! So why should they care or worry if we get sick...they don't pay the bill. We do and "sometimes we get destitute in doing so, and some of us die"...again, wouldn't be their problem either. It is also a nice way to smuggle in more of our tax dollars and make excuses for raising your tax dollars each and every year. You know how politicians are especially the ones we have in Congress right now. They'll make every excuse to increase or create a new tax while in the mean time, stealing your tax dollars through the little loop holes established through legislation, which is never read by the American people. I am for reform and I do believe that change is necessary, but is the Health care reform Democrats are proposing in Congress the right change? Thats my question and is it the only change or option or way? Absolutely not. There are many proposals right now. I am not looking for a band aid fix. This health care reform will leave many Americans vulnerable. It will eliminate competition and choice, and dictate American's decisions on issues that were once considered personal and private. It will force about 70% of Americans who are already insured to leave their doctors (some of whom they've had for many years) or least potentially will force them to. Also, it will cost triple the amount to maintain while the quality of your health care will decrease. Your putting the power of your health into the hands a very few and allowing them to make the decisions for you. While your taxes dollars (which you can guarantee will increase to ridiculous amounts as the years progress) are paying for the whole thing. Remember, who ever holds your money, controls your country. If government is generating billions of your tax dollars every year, they sure as hell are the ones who will be calling the shots and establishing and implementing the policies. I've heard some other proposals that are sounding a lot better than Obamas. I wonder why they are not getting any air time? I am deeply concerned. Please do not be fooled by the illusion. It's a bad fix for a deeply hurting America.
Concerned Citizen
"Why should they worry if we get sick? They don't pay the bill. We do - and sometimes we get destitute in doing so, and some of us die. Not their problem."-Joan
Your talking about the food industry, but what about our federal government? They are not paying for this system either, we are! So why should they care or worry if we get sick...they don't pay the bill. We do and "sometimes we get destitute in doing so, and some of us die"...again, wouldn't be their problem either. It is also a nice way to smuggle in more of our tax dollars and make excuses for raising your tax dollars each and every year. You know how politicians are especially the ones we have in Congress right now. They'll make every excuse to increase or create a new tax while in the mean time, stealing your tax dollars through the little loop holes established through legislation, which is never read by the American people. I am for reform and I do believe that change is necessary, but is the Health care reform Democrats are proposing in Congress the right change? Thats my question and is it the only change or option or way? Absolutely not. There are many proposals right now. I am not looking for a band aid fix. This health care reform will leave many Americans vulnerable. It will eliminate competition and choice, and dictate American's decisions on issues that were once considered personal and private. It will force about 70% of Americans who are already insured to leave their doctors (some of whom they've had for many years) or least potentially will force them to. Also, it will cost triple the amount to maintain while the quality of your health care will decrease. Your putting the power of your health into the hands a very few and allowing them to make the decisions for you. While your taxes dollars (which you can guarantee will increase to ridiculous amounts as the years progress) are paying for the whole thing. Remember, who ever holds your money, controls your country. If government is generating billions of your tax dollars every year, they sure as hell are the ones who will be calling the shots and establishing and implementing the policies. I've heard some other proposals that are sounding a lot better than Obamas. I wonder why they are not getting any air time? I am deeply concerned. Please do not be fooled by the illusion. It's a bad fix for a deeply hurting America.
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