Imagine if your organization changed its business plan completely every four or eight years. That’s what we do on health care costs and we are about to do it again as we switch from an emphasis on Medicare-led payment and delivery reforms to a focus favored by incoming Republicans on high-deductible insurance and capping federal spending in public programs.
One approach focuses on improving quality and reducing the volume of unnecessary services to produce greater value for the health care dollar. The other focuses on reducing the demand for health services and capping federal financial exposure in health. Whatever the merits of the two approaches, neither represents a comprehensive strategy for addressing health costs by dealing both with the price and volume of services and the push for more expensive technologies and drugs. Neither addresses the health cost problem the American people are most worried about, the steady rise in out of pocket costs and drug prices at a time when wage growth has been sluggish. The push for more high-deductible health plans could exacerbate it.
As health costs begin to rise more sharply we are again seesawing from one partial approach to another without a comprehensive strategy. And no camp – not Democrats focused on preserving the ACA’s coverage gains, nor Republicans focused on repealing the law and trimming back the federal role in health, nor the expert community enmeshed in provider-oriented delivery and payment reforms – is directly focused on the top priorities the American people have for the President and Congress in health. These include their deductibles, premium payments and other out-of-pocket costs, as well as their drug prices, surprise medical bills, and other pocketbook health care concerns that ripple through their family budgets.
There is little chance of a bipartisan comprehensive strategy on health costs in the current environment. But there could be room for a leader or leaders to define a consumer agenda in health that would resonate more strongly with the American people than the current agendas of the left, the right, or the expert community do.