Health

Use “COMPARE” for Better Policymaking

Twelve Suggestions for the New U.S. President

By Elizabeth A. McGlynn and Jeffrey Wasserman

Elizabeth McGlynn is the associate director of RAND Health. Jeffrey Wasserman is a RAND senior policy researcher specializing in health care reform.

Most politicians agree that the U.S. health care system is in crisis. Its ills are legion.

Health care spending is approaching 15 percent of U.S. gross domestic product, diminishing the profitability of American companies and crowding out other private and public expenditures. Ninety percent of Americans say that health care costs are a big or very big problem for the U.S. economy.

Also, there are serious quality problems. U.S. adults receive just over half of recommended care. Nearly 100,000 Americans die each year in hospitals from medical errors.

About 46 million Americans are uninsured. Among the insured, the availability of coverage is declining and the generosity of benefits is eroding.

The Gibel family of Senecaville, Ohio faced $30,000 in medical bills in 2008.

AP IMAGES/MATT YORK

With no health insurance offered through their jobs, and no money to purchase coverage on their own, the family of John and Delynn Gibel, of Senecaville, Ohio, faced $30,000 in medical bills in 2008. The only option, said John, was to declare bankruptcy.

Waste is rampant. About a third of U.S. health care spending produces no value. Examples include unnecessary services, duplication of tests, lost opportunities for early intervention, and inefficient delivery of care.

Americans aren’t getting what they’re paying for. Compared with people in other developed countries, U.S. adults have lower life expectancies, and U.S. children have higher infant mortality rates.

Most vexing of all, the complexity and fragmentation of the U.S. health care system has generated multiple competing demands from a wide variety of stakeholders, raising significant barriers to reform. It is nearly impossible to have a constructive, objective dialogue about the relative merits of different proposed solutions.

To advance the national dialogue, RAND Health is launching the COMPARE initiative. COMPARE stands for Comprehensive Assessment of Reform Efforts. At the heart of COMPARE is an online policy options “dashboard” — or a spreadsheet in the form of a control panel — that indicates the effects of policy changes on the performance of the U.S. health care system. The dashboard summarizes the status quo and the intended and unintended effects of different policy options across ten dimensions.

For example, the dashboard shows the known effects of an individual insurance coverage mandate, an employer mandate, or a Medicaid expansion on such outcomes as spending, consumer financial risk, health, and coverage. The COMPARE Web site also provides detailed information on the expected effects of many other policy options, of a range of legislative and other proposals to modify the health care system, and of the status quo.

RAND hopes COMPARE will serve as a valuable resource for the media, for legislative and executive staff at the state and federal levels, and for other public- and private-sector policymakers. RAND will not use the tool to design its own proposal, but others will be able to use the information to compare the pros and cons of various proposals.

Waste is rampant. About a third of U.S. health care spending produces no value.

Ultimately, users must make their own judgments about the wisdom of health policy proposals based on the trade-offs involved, the preferred priorities, and the expected magnitudes of changes, as suggested by the evidence to date. In some cases, there is no solid evidence with which to estimate the likely effects of reforms, leaving ample room for judgment calls. But for the first time, there is a strong foundation from which people with different value systems can discuss options based on a shared set of facts. square

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Health

Use “COMPARE” for Better Policymaking