Despite widespread agreement that it is critical to control health care costs and improve access to health care, “the evidence suggests that cost control is not being seriously confronted,” writes Daniel Callahan in the July 30, 2009 issue of The New England Journal of Medicine .

The three most politically popular cost-saving strategies – prevention, information technology, and comparative effectiveness research – “have been judged wanting,” writes Callahan, cofounder and President Emeritus of The Hastings Center and editor of The Health Care Cost Monitor, a Hastings Center blog. “They may work, but not well enough to make a great difference.”

Long-term economic survival depends on cutting the annual growth of health care costs in half to 3 percent, in line with gross domestic product, Callahan says. “Achieving this goal, however, will require nothing less than changes in medical and professional values, patients’ demands and expectations, industry profit seeking, research aims and aspirations, and the culture of American medicine, much of which has been dedicated to unlimited progress and technological innovation, cost be damned,” he writes.

Callahan proposes a framework for judging proposals to control health care costs: Is it likely to have a good, bad, or neutral health outcome? Is it technically and managerially feasible and economical? Is it politically acceptable or, with majority muscle, doable? And is it slow-paced or fast-paced?

“We know from other countries’ experiences which techniques hold down costs,” he says. Setting limits on care that doctors consider necessary, government price controls on pharmaceuticals, negotiated physicians’ fees, caps on hospitals’ annual budgets, and limitations on introduction of new technologies are some examples.

 But he acknowledges the obstacles to adopting these techniques here. “A way must be found to resolve a basic dilemma: cost controls that are likely to be politically acceptable will not be very effective, and what might be effective will not be acceptable,” he writes.