Solutions to Rising Health Care Costs Will Be Harder Today Than in the Early 1990s, Columnist Says
Although the U.S. health care system looked as bleak in the early 1990s as it does now, "[t]aking the steps required to restrain costs ... will be even harder today than it would have been" then, David Wessel writes in his "Capital" column in the Wall Street Journal. At the time of the failed Clinton health plan, "we had more reason to be optimistic," Robert Reischauer, the then-director of the Congressional Budget Office and current president of the Urban Institute, said, adding, "We thought we had the silver bullet, namely managed care. Politicians were willing to take on the issue. Businesses were willing to tell employees they had to go along with the program." While managed care led to "one-time savings" and helped control health costs in the mid 1990s, nothing "resembling reform" was implemented at that time, "[s]o old forces are reasserting themselves," namely increasing costs, Wessel writes. As for what happens now, Wessel writes that companies have backed off the idea that managed care will help "squeeze inefficiency out of the health care system" and save costs. Instead, companies now will look to shift more costs to their employees and educate them to be "smarter health care shoppers." Wessel concludes, "In short, Americans have an insatiable appetite for health [services], so they're going to have to pick up the tab" (Wessel, Wall Street Journal, 5/9).
With managed care "thoroughly ... discredited," disease management appears to be one of the more promising ways to control health care costs, Julie Rovner writes in her CongressDaily/AM "Health Matters" column. Disease management, also known as case management, involves the close coordination of care and increased education of people with chronic illnesses. According to Jonathan Lord, an official with Humana, "Financial results improve [from disease management] because patients become more engaged in managing their own health care, take better care of themselves, get care that experts say they should be getting, avoid care that does them little good, improve their compliance with drug regimens and generally experience improved health and functional status." Rovner writes that disease management looks "particularly promising" for Medicare beneficiaries, the vast majority of whom have at least one chronic condition. Medicare+Choice beneficiaries have access to disease management, but most seniors in the traditional fee-for-service portion of Medicare do not. However, more seniors are getting access to disease management programs through CMS-approved demonstration projects in various states, Rovner says. She concludes that "for a change," expanding disease management programs "may be a goal for Medicare that both Republicans and Democrats can agree on" (Rovner, CongressDaily/AM, 5/9).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.