There’s no way to address long term financial health in the U.S. without including Medicare savings in the mix. But political action has been stymied by fear among politicians that we over 65ers will rebel against any and every proposal to contain Medicare costs.
The politicians’ fears aren’t unfounded. With out-of-pocket health care costs rising even for well-insured Medicare recipients, it’s not irrational for over 65ers to see proposals for cost containment as stealth proposals for us to pay even more for our care than we do at present or to suffer from loss of important components of medical care. But this “lose/lose” perspective on our part overlooks emerging findings about the amount of “waste” in U.S. health care and the harms we over 65ers experience from overtreatment. As Berwick and Hackbarth argued in a 2012 JAMA article, discussed in this Health Affairs article, the lowest estimate of health care waste is 20 percent! In other words, there’s substantial opportunity for Medicare savings without (a) increasing out-of-pocket cost for Medicare beneficiaries, (b) reducing quality of care, or (c) further impoverishing future generations.
In order to focus attention on reducing waste and overtreatment, over 65ers who understand the potential for this “win/win” form of Medicare cost containment need to speak out. Political dialogue has been so dominated by “death panel” and “don’t let the government get hold of my Medicare” fears that we won’t get anywhere with regard reducing waste and overtreatment without a voice from the over 65 population on behalf of clinically informed, ethically justifiable Medicare reform.
I’ve recently joined with a group of young physicians and nurses who embrace the economic and ethical imperative for health professionals to help contain health care costs in a responsible manner. Costs of Care, a 501c3 nonprofit started by medical students and residents is a leading voice in this effort. Its three goals are exactly on target for what the U.S. health system needs:
ADVOCATE: creating a culture where caregivers are responsible for the cost and value of their decisions, take action to avoid waste, and help build the will for change
EDUCATE: giving caregivers the knowledge and skills they need to make cost-conscious, high-value decisions with their patients
SUPPORT: helping caregivers to deflate medical bills by using information technology and decision-support tools to put cost and quality information at their fingertips at the critical moment when medical decisions are made
We launched Over 65 to create a vehicle through which over 65ers could contribute to public deliberation about meeting the health and economic needs of the over 65 population in ways that consider intergenerational equity and the future well-being of our society. It’s heartening to see young physicians and nurses dedicating themselves to this same effort. Collaboration between over 65ers and thoughtful young activists could play a significant role in health system reform. We at Over 65 and my young colleagues at Costs of Care would love to hear your ideas on where savings could take place. Our plan is to publish relevant posts on both sites. I invite Over 65 readers who would like to participate in this collaboration to let me know via email.
James Sabin, M.D., 74, is an organizer of Over 65 and a clinical professor of psychiatry at Harvard Medical School. This post also appears on the Costs of Care blog.