Getting Control of Health Costs -- For Real

From Medscape General Medicine
Webcast Video Commentary
http://www.medscape.com/viewarticle/562544
Posted 09/14/2007

Michael Dukakis

Everybody talks about the cost of healthcare in the United States, and virtually
everybody has a solution. In fact, we seem to be hit with a new one about once
a week.

First it was HMOs and managed care. They clearly haven't done much to
stop double-digit health inflation, but they have managed to add billions
to the administrative overhead of the system.[1]

Then it was "consumer-driven healthcare." I call it "screw the little guy
healthcare," but big copays and high deductibles won't solve the problem
either.[2] What they will do is add even more administrative cost to the
system and virtually guarantee a flood of unpaid bills.

More recently we have heard about the wondrous cost-saving qualities
of "pay for performance" and electronic records -- and apart from the
billions that the latterwill require, there isn't the slightest evidence that
they will get healthcare inflation under control.[3]

Virtually all of these proposals are coming from people who tell us that
if only we can create a healthcare "market," and people can shop around
for their healthcare,
all will be well. The fact of the matter is that the market doesn't work
in healthcare. It never has and it never will -- for reasons that should
be obvious to anybody who has taken the time to study the subject.[4]

In the meantime, those advanced industrialized countries with whom
we like to compare ourselves don't spend any time indulging themselves
in the notion that the market can work in healthcare. And they seem
to provide pretty good medical care at half the price we do with better
health outcomes.[5]

How do they do it? They treat healthcare as a public utility and they
regulate its prices. And they do it with a fraction of the administrative
overhead and bureaucracy that plague our system.

So maybe it's time to show the health marketers the door and get
serious about universal coverage in this country with cost controls
that are reasonable, fair, and effective. If we don't, I believe we are
doomed to massive increases in health costs for as far as the eye
can see.

That's my opinion. I'm Mike Dukakis, the former Governor of
Massachusetts.

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