our own system

Ezra Klein:

Eventually, we’re just going to have to get the growth of health-care costs down. There’s simply no other way.

Predicting the healthcare future is difficult; it is even more so now that we have reform measures in place. Will it work? Won’t it work? I’d argue, strictly in a sustainability sense (i.e., not including any moral arguments regarding healthcare access for everyone) that it doesn’t matter.

It doesn’t matter whether healthcare costs continue to rise or not because we’re already spending too much. Healthcare expenditures in state budgets, right now, are first (or at least in the first breath of the conversation) on the list for targeted cuts. The Medicare “doc fix” that prevents a 20%+ cut in physician reimbursement is routinely on the table. Etcetera.

It all goes back to Mr. Klein’s statement. There is no other way to lower budget deficits than to reduce the growth of healthcare costs. In our mashed-up government controlled/free market system of paying for healthcare, it likely will mean heavy handed cost limiting tactics by the powers that be.

This presents a very difficult problem to local providers (hospitals, independent physicians, etc.). It’s easy to sit in an office somewhere in middle America looking at the U.S.’s annual healthcare spend and perfunctory percentage cost increases and think the problem doesn’t rest with the one reading the reports.

It’s not me. It’s those free-spenders in Miami. It’s the drug companies, or the device makers, or the insurance companies.

No, that’s not right. It’s all of us. Yes, to varying degrees. But it’s all of us. Treating patients is an expensive business. It continues to get more expensive.

It would be naive to think that coming cost reductions are only going to impact the other guys. They’re going to impact us. No one is going to voluntarily turn back their revenues for the good of the rest. Most individuals and organizations would claim one of two arguments: 1) we’re being paid adequately for the good we provide and 2) we’re not getting paid enough for the good we provide. Few, if any, are going to tell anyone their making more than they should.

Kevin Kelly calls it the Shirky Principle:

Institutions will try to preserve the problem to which they are the solution.

This may be naive, but it is realistic: it’s time for a new operating paradigm on the provider side. No longer can it be about how we can get paid more for what we do. It needs to become: how can we provide care to patients at a lower cost than what we did yesterday without sacrificing outcomes or quality or safety.

Call it the “Do More With Less Principle.” Take that to the office on this Tuesday morning as you return with an extra hop in your step from the long weekend.