commentary

(The Tennessean)

August 29, 2009

Stick to Facts to Find Health-Care Change That Works

by Elizabeth A. McGlynn and Jeffrey Wasserman

The ferocity of the national debate over health care continues to build, and rhetoric has all but replaced reality. People on all sides of the issue appear to want anything but the facts.

Policymakers need more light, not more heat. The RAND Corp. has recently completed a number of studies that may help inform the debate. For example, we analyzed several ways of expanding health-care insurance to the 45 million or so individuals who now lack it. Our results indicate that if the nation as a whole were to adopt a Massachusetts-like plan, which involves requiring most employers to offer coverage, most people to obtain coverage and a modest expansion of the Medicaid program, the number of uninsured people in the country would decrease by up to 85 percent. Total health spending would increase by about $30 billion a year.

To put the $30 billion in perspective, the United States will likely spend $2.5 trillion on health care this year. So our results indicate that by increasing health expenditures by just over 1 percent, the nation can insure an additional 38 million people. Not a bad deal.

But the health-care debate is certainly not all about increasing insurance coverage. Policymakers must also tackle rising health-care costs. Unfortunately, careful analyses reveal no panaceas. In a recent study for Massachusetts, RAND examined 21 policy options for controlling health-care costs. These included reforming payment systems, redesigning care delivery, reducing waste, engaging consumers in cost containment and reforming medical malpractice laws. For many options, RAND was unable to find strong evidence regarding their cost-containment effectiveness. Other options yielded only modest savings.

But some policy changes would work. Changing the ways physicians and other health-care providers are paid for the services they provide, expanding the use of health information technology and regulating hospital payment rates, would, in all likelihood, help stem the rate of increase in health spending. These measures would also buy the nation time to develop and implement more promising cost-savings measures, such as new ways of organizing the delivery of care that achieve the kinds of successes seen at places like the Mayo Clinic and Geisinger Health System.

As policy analysts, we have been trained to always consider the status quo as one policy option. So what can the country expect if nothing is done to expand coverage or limit cost growth? Researchers from the Centers for Medicare and Medicaid Services estimate that, between 2009 and 2018, health-care spending will increase by 70 percent and account for 20 percent of the gross domestic product. By 2010, an additional 6.9 million people will join the ranks of the uninsured.

In our view, doing nothing is not a viable alternative. It would consign Americans to a path that virtually none would choose to take. Although there are differences among health system stakeholders, we also believe there is a remarkably large expanse of common ground. By focusing on the facts and setting aside beliefs that are not supported by the facts, cooler heads can still produce meaningful health-care reform.


Elizabeth McGlynn is associate director of the health program and Jeffrey Wasserman is senior policy researcher at the RAND Corp. (www.rand.org), a nonprofit institution that helps improve policy- and decision-making through research and analysis. They are in Nashville to participate in today's public forum on health-care reform at Schermerhorn Symphony Center.

This commentary appeared in The Tennessean on August 29, 2009