While politicians debate how to avoid falling off the fiscal cliff that they created themselves, not many people are talking about smart ways to lower health care costs.
The idea most often mentioned in recent days is that the U.S. should raise the age when people become eligible for Medicare. It's a tactic that even the least thoughtful member of Congress can understand–save money by denying care to millions of people. Easy for Washington to understand, but maybe not so easy to understand for those millions who are denied care.
Such a crude move seems foolish in light of the years of research that have shown many, many ways to lower health care costs intelligently, with far fewer adverse consequences. You can find hundreds of such studies and proposals in the journal Health Affairs and in many other medical and scholarly journals. To take one example, the current issue of Health Affairs features a study showing that giving patients access to their primary care doctors after hours reduces the number of costly emergency-room visits.
These thoughts were prompted by an Op-Ed commentary in The New York Times that proposes another smart and inexpensive way to lower health care costs: Encourage middle-aged people to take aspirin.
The Op-Ed's author, David B. Agus, shares my concern about the debate in Washington. "Our conversation has focused almost exclusively on how to pay for that care, not on reducing our need for it," he writes. And when we find ways to reduce the need for care, officials should make it public policy to encourage them.
That's the case with aspirin, he says. It can lower the risk of heart disease in many people, and more recent reports suggest it can also help prevent certain kinds of cancer. Some might dispute the details of this research, but the overall thrust is clear. "So the question remains," Agus writes. "Given the evidence we have, why is it merely voluntary for physicians to inform their patients about a health care intervention that could not only help them, but also save untold billions in taxpayer dollars each year?"
This isn't quite as simply as denying people Medicare–but it's close. And aside from the economics, it saves people a lot of pain and suffering. Not having a heart attack is better than having one, and it saves money, too.
Reporters following the debate over the fiscal cliff are endlessly analyzing the politics, but few are questioning the policies that might emerge from this self-imposed, 11th-hour negotiating. Some readers and listeners might find the politics entertaining or disturbing–I'm one of them. But the far bigger issue for all readers is how to stay healthy, what it's going to cost them–and whether Washington is making smart decisions about that, rather than simply lopping people off of Medicare. The mainstream press that is so busy with the politics should be covering the policies, too.
[Update 12/18/12: For more on David Agus, including questions about whether he has over-promoted certain scans and other preventive measures, click my follow-up to this post.]
-Paul Raeburn
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