While most of the discussion about health care insurance is fixated on rising premium rates which are certainly a problem, not nearly enough time and energy is spent on looking at the cost side of health care. In a recently published article in USA Today it was revealed that 5% of all patients in the US account for fully half of health care spending. This is not an indictment of these patients, all of whom are obviously in poor health. Rather, it should be a jab to the ribs of those on the delivery side of health care to look for ways to intervene sooner with these patients.
Dr. Atul Gawande has been covering this beat for several years now, but his work and that of others who are on the front lines of providing health care need to become part of the national discussion about health care. The extreme costs associated with treating the sickest patients are often due to some surprising non-medical social problems such as lack of affordable housing, punitive immigration legislation, and non-medical follow up with patients who are chronic users of emergency services. If we strip away the politics of how these patients ended up in such dire straits, reducing their usage of medical services can often be done at a surprising low cost. The result is better patient care at a much lower cost. These lower costs reduce the cost of both private medical insurance and public plans such as Medicare and Medicaid. Until we tackle the difficult issue of managing costs, we will hover on the surface of health care reform where political posturing trumps substantive discussion.