Bill Emmit,
CEO of one of the largest and most
influential mental health lobbying groups in DC, recently sent an e-mail to the
CEOs of all the organizations who are part of the lobbying group, Campaign for Mental Health Reform. In his
message, he attached part of a story
from The Washington Post.
In the story,
writer Lori Montgomery notes that DC "think tanks" and policy bodies are
beefing up their health care staff in an obvious move to prepare for intensive
work fixing our broken health care system during the next administration. For
example, she notes that "The Congressional
Budget Office has nearly doubled its health policy team, hiring 21
people in the past year. The Brookings
Institution has snatched up more than a dozen researchers for a new
center devoted to health-care innovations."
Why the
flurry of activity to "fix" health care?
- 47
million people-16 percent of the U.S. population-do not have health
insurance.
- Spending
on health care already consumes more than 15 percent of the nation's economy
and about a quarter of the federal budget.
- As
a population, we spend more money on health care than on either housing or
food.
- Health
care spending is growing at a rapid pace, exceeding GDP* growth by about 2 1/2 percentage points, on average, over the past four
decades. If that pace continues, health spending will exceed 22 percent of GDP by 2020 and will devour half of all federal
spending by 2050.
*GDP stands for "gross
domestic product," which also means "gross domestic income."
And while
we all cheer the progress in Congress of mental health parity, what will that
mean in a broken health care system?
Managed
care—long thought to be the salvation of the health care system—turned out not
to work. As the bumper sticker says, "Managed care is neither." More managed
care seems unlikely to provide greater cost effectiveness.
Long
touted by the Republican side of the fence, health care savings accounts have
not caught on. Why anyone is surprised by that is beyond me ... as a country, we don't
tend to save money for anything, let alone set aside pre-tax dollars to
cover out-of-pocket health care expenses.
So, it's time
for new solutions and, clearly, policy makers are gearing up for just that. What
could we see in the future?
A trend
we're seeing and hearing a lot about is tiering low costs/high quality
providers. Tiering, or incentivizing,
providers who provide both high quality and low cost seems risky at best. A
tiering program would do two things: It would pay certain doctors more, and it
would encourage you and me to see these top-tier doctors by reducing our co-pay
when we do. If insurers pay doctors who have lower costs and more great
outcomes, will those doctors start to "cherry pick" only the "least ill" among
us so they can keep those low costs and high outcomes? Will that mean that those
of us with chronic conditions—say, like, mental illnesses—be left out in the
cold with higher co-pays and lower quality doctors? And who determines how quality is defined anyway?
