In his inaugural address today, President Obama made a reference to access to and the cost of healthcare. Health care will clearly be a top issue for the new administration, but one which will still be overshadowed by the overall state of the economy. Cost and access to healthcare is an economic issue also – the CEOs of several large companies have suggested that a universal, government based system of some sort would bring relief to companies with older workforces, and the concurrent health problems and costs.
Washington Post columnist David Brown, who is a medical doctor, recently wrote, “We are on a collision course between our wish to live longer, healthier lives and our capacity to pay for that wish.” In discussing the coming debate and discussion over the financing and organization of healthcare in the
“What we’re unlikely to hear, though, is something like this: ‘
Arresting the growth of health care spending in the
Citing studies, Brown suggests that it cost for each medical advance. Sixty years ago, relatively inexpensive advances – clean water, vaccines and antibiotics helped to make dramatic improvements in the quality of life and life expectancy. To achieve further advances are much more expensive, and legitimate questions are raised as to whether the benefits make any real difference in quality of life and longevity. Prevention that prevents or mitigates morbidity and mortality also costs – where are the best investments to be made? Conversely, Brown does point out that there are areas where savings can be made, such as in overhead and administrative costs.
Finally, Brown raises the Malthusian Spectre as applied to healthcare- the notion that healthcare costs will rise and nothing can stop or change this trend. But the demographic Spectre was thwarted, as birth rates declined and the efficiency and quantity of food production rose.
I see several challenges and goals ahead:
1. Universal coverage: mandated, and governed by (though not necessarily run by) the federal government.
2. Attack and improve clinical effectiveness and efficiency
3. Attack administrative efficiency and effectiveness
4. Continue to innovate new clinical and administrative methods
That’s our challenge. That’s our future. There is opportunity there, because as Samuel Johnson said: “If you ain’t got the money, you got to think”.