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Money & Medicine: Lessons for Fixing the Fiscal Cliff?



December 20th, 2012

The author previously led national quality and patient safety initiatives at the Robert Wood Johnson Foundation, including its twelve-year program to bring palliative care into the nation’s hospitals. She is the principal author of The Treatment Trap, The Battle Over Health Care: What Obama’s Reform Means for America’s Future, and the forthcoming book, Medicare Meltdown (Rowman & Littlefield, March 2013). She has previously written for Health Affairs journal and for GrantWatch Blog.

Raise the Medicare eligibility age? Increase Medicare premiums?

As winter arrives in Washington, these proposals have surfaced in the fiscal cliff debate that is reaching a boiling point.

Is there a better way to control spending that doesn’t require shifting cost burdens to patients and taxpayers? The answer is a resounding yes, according to the documentary film, Money & Medicine, which aired this fall on PBS.

The film shines a light on uncontrolled health care spending, much of it occurring because of overdiagnosis and overuse of health care services. It hints at the following conundrum: pressure within health care organizations for constantly growing revenue is diametrically opposed to the need for affordable health care for patients and families, employers, and federal and state governments.

The film was funded with the support of these foundations: the Fledgling Fund, Charles A. Frueauff FoundationW.K. Kellogg Foundation,  Missouri Foundation for Health, Odyssey Fund, Park Foundation, Silverweed Foundation, Spunk Fund, and Trull Foundation. 

Money & Medicine paints a stark picture of what will happen if health care spending is not controlled: the federal government’s debt will increase, more costs will be shifted to patients and taxpayers, and health care will be unaffordable.

My favorite depiction of the unsustainable trajectory is captured in a Congressional Budget Office graph, tucked away in an appendix of a 2007 report. It shows that if health care spending continues to grow at historical rates relative to the gross domestic product (GDP), then, by 2082, the US will spend 99 percent of GDP on health care. Surely policy makers will intervene to prevent that from happening, because otherwise there will be no money for food, housing, education, infrastructure, and all the other necessities of life.

Money & Medicine reveals how end-of-life care is still broken in many ways, and this results in suboptimal treatment and care. These challenges remain, notwithstanding the millions of dollars in investments made by foundations and other funders to improve care for people with serious, life-limiting illness. These funders include the Robert Wood Johnson Foundation, which at one time was very active in this funding area. The establishment of palliative care as a medical specialty, and the increase in the number of hospitals with palliative care units and consultation teams, have not been sufficient to stem the tide of the medical-industrial complex.

The film provides a hint that the mix of money and medicine is not the sole challenge. Together, they can contribute to patient harm. Harm from overuse of health care might be a greater motivator for reform than falling over the money cliff. Perhaps a stronger case could have been made if patients had a more pronounced voice in the film.  

For solutions, Money & Medicine highlights ways to reduce health care spending: using evidence-based medicine, promoting shared decision making with patients, and strengthening care coordination. Are they powerful enough to do the trick? It’s not so clear, but they are a start.

Although these prescriptions for change have not surfaced during the fiscal cliff debate, the film provides a compass for where to look for solutions when the political will exists to implement such changes. They would likely garner overwhelming support from the public—surely compared with proposals that would raise the Medicare eligibility age and Medicare Part B premiums.

Can the political will be created to bend the cost curve? There are no easy answers, and the nation doesn’t have much time or money to wait. Still, the film brings more clarity about what is at stake. That’s a good thing.

Related resource:

WNET’s public television station THIRTEEN press release on Money & Medicine: http://www.thirteen.org/13pressroom/press-release/money-medicine/. THIRTEEN is a station in the New York City area.

 

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