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Amy in the News

Klobuchar, Durenberger: Cost, access matter. But focus on health-care quality is key

April 15, 2009

By Amy Klobuchar and Dave Durenberger, Pioneer Press

http://www.twincities.com/opinion/ci_12048512

In his first two months in office, President Barack Obama has focused on the essential importance of health care reform to America's future prosperity and fiscal stability. Reform will not be easy. It requires strong, nimble leadership to break through the inertia that for too long has been the most powerful force in Washington. It also requires a true spirit of bipartisanship.

One of us is a Republican who served in the U.S. Senate for 16 years and has the health-care-reform battle scars to prove it. The other is a Democrat who joined the Senate two years ago and has fought to make health care more affordable, including better preventive care and lower drug prices.

Both of us believe in fiscal responsibility and the goal of universal coverage. We also believe the traditional health reform debate, framed by a simplistic "market versus government" mindset, has become an obstacle to progress.

Any viable reform must aim to win the trifecta of greater affordability, better access and higher quality.

America's problem with health care costs is already well known.

At $2.4 trillion per year, health care spending represents close to 17 percent of the American economy, and it will exceed 20 percent by 2018 if current trends continue.

Government pays much of the bill. Health care alone accounts for about one-quarter of total federal spending. With the aging of the baby boom generation, Medicare spending is projected to increase dramatically.

For some time, Peter Orszag, now Obama's budget director, has warned that rising health costs are "unsustainable" and "represent the central fiscal challenge facing the country." It is tough talk, but it is true.

America's problem with health care access is also well known.

Despite all that our nation spends, 47 million Americans have no health care coverage, and that number is increasing. Millions more struggle to afford the health care they have. Meanwhile, businesses are squeezed on the bottom line, forced to reduce or drop health coverage for their workers.

A third problem receives much less attention: quality. It is the Rodney Dangerfield of the health care reform debate. It gets no respect. But any reform that threatens to sacrifice quality will not, and should not, get very far with the American public.

A focus on better quality is, in fact, one of the keys to successful reform, because much of America's health care spending simply does not produce quality outcomes.

The problem is not just administrative waste and inefficiency. In certain parts of the country, it also includes high volumes of medically unnecessary tests, procedures and hospitalizations.

Pioneering research by Dr. Jack Wennberg at Dartmouth finds that, in the reverse (and perverse) economics of health care, the supplier instead of the customer gets to determine demand. Surprisingly, the most expensive health care is often far from the highest quality health care.

The best place to start with reform is Medicare, the largest single purchaser of health care in the country. Both providers and private insurers take their lead from Medicare.

Despite periodic attempts at reform, Medicare still pays providers based on quantity, not quality. As a result, Medicare pays vastly more in some parts of the country than it does in others. States with excessive and expensive medical care are in effect rewarded for these practices. Cost-effective states, like Minnesota, are punished.

Producing greater value in health care is not a mystery. While the new economic recovery package rightly dedicates additional funds for research on comparative effectiveness, we already know plenty about how to improve outcomes and save money. Some of the very best medical institutions in the country already do it.

For example, the Mayo Clinic is widely admired for its top-quality care. Much less well known is that Mayo provides this care at relatively low cost.

According to the Dartmouth research, Medicare could save as much as $50 billion over five years if all hospitals cared for chronically ill patients in the same highly rated manner as the Mayo Clinic does — by managing care more efficiently and ultimately improving health care outcomes for patients.

The gold standard in medical care proves to be penny-wise. Other providers achieving similar or even greater success include Geisinger in Pennsylvania, Intermountain in Utah and the Marshfield Clinic in Wisconsin.

To reward value over volume means a preference for providers who:

# Adopt evidence-based best treatment practices

# Embrace the "bundling" of services for a single reimbursement rate.

# Focus on patient-centered coordinated care to prevent hospitalizations.

# Engage patients and families in managing their health.

# Make better use of information technology to reduce not only administrative waste, but also expensive and even life-threatening medical errors.

Maximizing value is not a miracle cure. But without it, meaningful reform will not succeed. With it, we have a much better chance of making America's health care more affordable, more accessible and more effective.

Amy Klobuchar represents Minnesota in the U.S. Senate. Dave Durenberger is a former U.S. senator from Minnesota.