TUNNEL VISION

A New York Times piece by Annie Lowrey from 4/28 discussed a ray of light at the end of the health care spending tunnel, “offering some fuel for optimism about the federal government’s long-term fiscal performance.” It seems that total nationwide health care spending grew less than 4 percent per year in 2009 and 2010, “the slowest annual pace in more than five decades.”

Several factors were surmised as accounting for this: the recession, with many patients now without health insurance and others skipping medical visits due to worries about job security, the greater use of generic drugs in the wake of “a dearth of expensive, novel drugs coming onto the market,” and the shift toward accountable care, where quality rather than quantity of care is reimbursed.

Still, “[s]ome experts caution[ed] that there remains too little data to determine whether the current slowdown will become permanent, or whether it is merely a blip caused by the economy’s weakness.”

As with the general economy, I encourage readers to look past the fog of “expert” opinion and at fundamentals when deciding where we’re headed. Remember, there was a collective silence from the experts just before the economy tanked in 2008. All of the above reasons for the medical spending slowdown cited, in my opinion, are accurate. However, one of them requires ongoing economic failure for us to “succeed” in capping health care costs, the other a lack of innovative new therapies, and the third a shift to a managed care model of health care delivery (the hazards of which I’ve previously discussed). On a more positive note, the article states that many people have moved into high-deductible plans and thereby reduced their spending by 14 percent, proving once again that when the consumer is back in the loop, market corrections follow. The downside is that some of the savings were carved out of essential spending, such as that used for vaccinations, and will have health and dollar repercussions in the longer term. It should also be remembered that health care spending did increase yearly with the percent of the GDP remaining flat, at just under 18 percent.

What the “experts” may be missing is that an enormous group of aging baby-boomers are about to storm the health care citadel. In my bailiwick, I see high-cost new devices rolling out to prolong the life of the very elderly a few more years—often the very elderly with multiple other medical problems requiring expensive attention, many of whom will have limited quality of life at the end. I see murderers and sexual predators receiving costly and extraordinary care rather than palliation so we can spend more on their incarcerations for untold years to come. In short, I don’t yet see a clear societal attitude change.

We need to actually deal with these thorny issues up front. Or the tunnel will collapse before we reach the light.

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