Cutting healthcare costs

Leslie Alderman in a New York Times column (“Patient Money - How Doctors Would Cut Health Care Costs,” March 26, 2010) recommends nine ways to reduce the cost while improving the quality of healthcare in the United States. Those recommendations, from prominent physicians, merit careful consideration:

1. Insure catastrophes only. Comparable to auto insurance and other forms of insurance, require people to pay for routine issues themselves or to opt for additional healthcare insurance at their own expense.
2. Change malpractice law to make it harder to prove malpractice and reducing the size of settlements, diminishing the pervasive practice of healthcare providers ordering excessive tests to avoid any possibility of error.
3. Counsel nutrition. Good eating habits demonstrably improve health.
4. Rely on evidence-based medicine. Fund only those treatments for which scientific data exists that support the treatment’s efficacy.
5. Allow expertise to occasionally override the dictates of evidence-based medicine. This recognizes that human decision-making capabilities are superior to computerized algorithms.
6. Support integrative medicine, e.g., encourage patients to see the same provider consistently and to account for the effect of the non-medical on physical health.
7. Pay to treat childhood obesity. Childhood obesity causes multiple problems later in avoiding, making the cost of early intervention less than the cost of later treatment.
8. Stop overtreating. Excessive intervention occurs both for the dying (sometimes when the evidence shows no known treatment to be efficacious or the cost in suffering from treatment likely exceeds any improvement in quality or length of life) and for the well (defining new diseases when perhaps none exists, e.g., sleep disorders and sexual dysfunction).
9. Restore the humanity in the relationship between patient and healthcare provider.

These nine proposals are certainly not ukases that will fix the broken U.S. healthcare system. However, the proposals offer a starting point for a discussion about ways to reduce the costs of healthcare in the U.S. without risking diminishing the quality of care.

Given the violent – literally violent – reactions to recent healthcare legislation, any hope for a civilized debate about the immense costs of healthcare in the United States seems remote. Furthermore, although the new legislation moves the United States closer to universal coverage, approximately 5% of the populace will remain without healthcare coverage. One important contribution that people of faith – all faiths – can make to the ongoing controversies about healthcare is to encourage people to engage in rational conversation respecting the divergent views of those with whom they disagree.

Living in community entails living with other people. Given the individual uniqueness of humans, that means some, perhaps even most, people will inevitably disagree with me or with you, regardless of the passion with which we hold our position. Disrespecting the dignity and worth of others, verbally and particularly violently, has no place in public discourse. Indeed, we denounce terrorists because they introduce violence into the public square when they feel unable to prevail through rational discourse and non-violent means.