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  • BIOETHICS FORUM ESSAY

The Health Care Cost Monitor

Much to the amusement of my colleagues, families, and even idle bystanders who know me as a congenital book, newspaper, and magazine type, I am starting a blog, The Health Care Cost Monitor. Its aim will be to assess and judge the cost of health care, a now monumental problem. My interest in the subject emerged long ago. Slightly over 20 years ago I was invited by the Office of Technology Assessment (OTA) to take part in a study of the impact of new medical technologies on health care costs of the elderly in the Medicare program. The OTA agency, as with other technology assessment efforts initiated by Congress, was eventually shut down in 1995. Neither the medical technology industry nor any other industries wanted to have their products assessed for their economic and social impact.

But I got hooked on the problem of the elderly and health care costs. The first inkling of an eventual crisis for Medicare was just beginning to emerge in the mid-1980s, and it has become worse and worse every year. As the Medicare Trustees just told us, in about eight years that program is projected to run out of money. Medicare was not, however, the only part of American health care having problems. The system as a whole was then, and is even more now, in desperate straits because of a too-high rate of annual inflationary increase, now in the 6 to 7 percent range a year, quite enough to double health care spending from $2.4 trillion to $4.4 trillion a decade from now.

Why a blog? It is fast and reaches many new audiences. Given the prominence of the cost problem, I was surprised to discover that there are none exclusively devoted to costs, despite the existence of dozens on health care. The topic, I long ago concluded, makes everyone nervous, politicians in particular. There is no way to be serious about cost control without a willingness to entertain unpleasant policy ideas, to be willing to say no to patients, doctors, and the medical industry – to speak that dread word, rationing.

It is not that the issue is ignored. It is well publicized, a part of every reform agenda, and much talked about. But most of the talk is of the soft and sweet uplifting kind, full of grand ideas and popular nostrums, practically none of which have much promise of controlling costs. Think of health information technology, comparative effectiveness research, and disease prevention – all of them touted but none of which pass close scrutiny for likely effectiveness.

President Obama underscored the difficulty of the problem from a personal perspective in a recent interview in The New York Times Magazine. One the one hand, he acknowledged the government’s “obligation” to control health care costs but on the other, speaking of his dying grandmother, he said:

“Whether, sort of in the aggregate, society making those decisions to give my grandmother, or everybody else’s aging grandparents or parents, a hip replacement when they’re terminally ill is a sustainable model, is a very difficult question. If somebody told me my grandmother couldn’t have a hip replacement and she had to lie there in misery in the waning days of her life – that would be pretty upsetting.”

The point of the blog will be to take a close look at health care costs and costs more generally, to see what might work to manage them, what might be politically acceptable, and what might be tolerable to the public. My colleagues and I have recruited a fine range of national and international analysts and commentators to write for the blog. Comments from our readers will be welcome. Most important, as the reform plans of Congress and the Obama administration begin to take shape in proposed reform legislation we will stay on top of them, following the debate as it moves along.

The cost problem is not only difficult and contentious, it has a special urgency. Unless it can be solved, or great progress made, the health care system will continue to fall apart: more uninsured, higher copayments, deductibles, and out-of-pocket expenses for those of us with good insurance, and more general misery all around. And even if our country is lucky enough to get some form of universal care, it will soon fall apart if cost escalation is not stopped. Are you nervous about that? If not, you should be.

Joining me as editors will be Susan Gilbert, Polo Black Golde, and our Director of Communications, Mary Crowley.

Daniel Callahan is Senior Research Scholar and President Emeritus of The Hastings Center and author of the forthcoming book, Taming the Beloved Beast: How Medical Technology Costs are Destroying Our Health Care System (Princeton University Press).

Published on: May 18, 2009
Published in: Health Care Reform & Policy

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