health-care rx

Health Care Rx panelists debate the costs of Congress's reform bills

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Wednesday, November 4, 2009

Excerpts from Health Care Rx, where experts debate their policy prescriptions for the health-care system. For the full discussion, go to

John J. Whyte, M.D., is the chief medical expert for the Discovery Health Channel.

Keep in mind that Congress, historically, has actually done little to control costs. In some ways, it has helped create a system, through its payment policies, that increases costs. For instance, reimbursement from Medicare primarily rewards procedures and pay for "sick care," not health care. It pays well for a colonoscopy, imaging study or balloon angioplasty, but not for the time to adequately explain why a test or procedure is or is not necessary, or how lifestyle changes can be just as effective as more expensive and invasive interventions. It has in the past helped cover the cost of training physicians irrespective of specialty choice and the need for particular types of physicians. These financial incentives have increased the number of procedure-based specialists, which in turn increases costs further. It's not surprising that more medical students want to go into dermatology, radiology or orthopedic surgery, which can pay two or three times in salary compared with internal medicine or family practice.

Sreedhar Potarazu is an ophthalmologist and the founder and chief executive of VitalSpring Technologies, which creates software for employers to manage health benefits.

While Congress struggles to merge bills over the next few weeks, it is clear that the fundamentals for what will ultimately improve the cost and quality of health care have been overlooked. Every part of our economy, from consumer goods to food to airline tickets, has been transformed by an empowered consumer/purchaser who has the necessary transparency to make choices, comparisons and decisions and ultimately drive down cost and improve quality . . . except health care.

Michael J. Critelli was chief executive at Pitney Bowes, a mailing services company, for 11 years, where he innovated in employer-based health care.

Unfortunately, the multiple bills passed through various House and Senate committees do not go far enough to create a broad-based payment system that rewards integrated, low-cost, high-quality care. The fundamental flaw in all of these proposals is that they are based on the assumption that if everyone has health insurance, they will get more and better health care. However, health insurance access is not the same as health-care access, and getting easier access to health care does not significantly improve population health. Until we make people so much healthier that they do not need to use the health-care system as much, we will not reduce cost increases.

Robert F. Graboyes is the senior health-care adviser at the National Federation of Independent Business in Washington.

Current legislative proposals heavily emphasize insuring the uninsured, rather than bringing down costs for those who already have insurance. Coverage expansion is an admirable goal but adds costs rather than subtracting them. Similarly, there are new incentives for wellness and prevention -- also admirable, but also cost-increasing. To its credit, the Finance Committee bill has a number of positive features, notably the design of and rules for health insurance exchanges for small-business owners and employees.

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