Keeping Health Care Costs Down: NYT Misses the Boat

The New York Times has a humongous but very disappointing editorial in today's paper about the various issues we will have to address as a nation to keep health care costs down. Unfortunately, the editorialist ignores the big issues and manages to use a lot of words to say very little. First, an overview of the solutions the Times suggested:

Geography: Some areas of the country have more economical health care than others, without much difference in outcome: "If the entire nation could bring its costs down to match the lower-spending regions, the country could cut perhaps 20 to 30 percent off its health care bill, a tremendous saving."

Stick to What Works: "The sad truth is that less than half of all medical care in the United States is supported by good evidence... If doctors had better information on which treatments work best for which patients, and whether the benefits were commensurate with the costs, needless treatment could be junked, the savings could be substantial..."

Managed Care: "Managed care techniques are creeping back into some health plans, especially for services apt to be overused, but too heavy a hand would most likely produce another backlash."

Information Technologies: Increased computerization is needed: "There is little doubt that widespread computerization could greatly reduce the paperwork burden on doctors and hospitals, head off medication errors, and reduce the costly repetition of diagnostic tests as patients move from one doctor to another."

Other issues mentioned: Prevention, wellness programs, disease management, and drug prices, none of which offer great savings.

Here are 10 more difficult issues that involve cost contained that the Times' timid editorialist didn't address:

1. The cost of paying for undocumented/illegal aliens. This is the elephant in the living room that too many advocates refuse to address for fear of being branded xenophobic or worse.
2. Health care rationing. Is it needed? How would it be imposed?
3. The cost of paying for uninsured people at emergency rooms.
4. The cost of 50 state private insurance markets instead of a national market.
5. The cost of full tab health care systems. Any nationalized or required private insurance system will have to be bare bones to be affordable.
6. The cost of defensive medicine. The NYT generally opposes tort reform (as generally do I), but it needs to address this issue.
7. The lack of competition as to price in the current system.
8. The cost of over utilization due to low deductibles and co-pays.
9. The puzzling continued high cost of medical technology despite economies of scale.
10. The place for private health savings accounts.

The cost of health care is a huge issue that we need to discuss in the coming election. But bland editorials that don't say very much--not to mention anything controversial--are not the kind of hard-hitting opinion pieces we need to stimulate the painful and provocative debate required to come up with a democratically attained solution to this increasingly pressing problem.