Professors Katherine Baicker and Amitabh Chandra write in the most recent edition of Health Affairs about the myths that hinder healthcare reform. They argue that correcting these misimpressions will allow us to address the fundamental challenges facing the American healthcare economy. So what are the myths?
(1) that the problem is the inability of the uninsured ill to find affordable health insurance;
(2) that the cost of insurance coverage for the uninsured will be offset by the savings from the reduction in expensive and inefficient emergency room care;
(3) that the lack of insurance is the principal barrier to high-quality care;
(5) that employers can shoulder more of the insurance cost burden;and
(5) that high-deductible plans and competition, rather than government action, are the key to lower costs.
Baicker and Chandra present some fundamental challenges to the current healthcare reform discourse. They point out that insurance by definition is far from a panacea, and is in some respects a problem in itself. With regard to the emergency room, for example, the evidence is that any savings from fewer expensive emergency visits are offset by the greater consumption of health care services that takes place once patients have insurance:
in general, prevention is good for your health, not your wallet. Some preventive care has been shown to be cost-saving–such as flu vaccines for toddlers or targeted investments such as initial colonoscopy screening for men ages 60-64–but most preventive care results in greater spending along with better health outcomes.
The authors challenge some other sacred cows of the healthcare debate. We often assume that the problem is limited to the uninsured, but an ignored issue is the difference in quality of care that the insured receive based on geography: patients in certain high-spending areas “see more specialists more frequently, have more diagnostic and imaging services, and get more intensive care at the end of life–none of which has been shown through clinical trials to improve health.”
Legislators whose solutions focus on the panacea of universal insurance should take note of the authors observation that
[i]nsuring the uninsured will give them access to the sort of health care that everyone else receives: a combination of valuable care, overuse of some costly interventions with little proven benefit, and underuse of some vitally important therapies–care that is sometimes coordinated but often fragmented. This is better than no care, but it highlights the problem of collapsing the entire debate about U.S. health care reform down to the issue of uninsurance: health insurance does not guarantee good health care.
With major healthcare reform looking like a reasonable possibility this year, Baicker and Chandra’s article should be required reading.
