Archive for March, 2010

The Health Care Debate and Basic Research

March 24, 2010

There are two fundamental issues dealing with health care in the U.S.:  coverage and costs.  Currently, far too few people are covered by health care plans, and the costs of health care delivery is very high and increasing rapidly.

In the recent health care debate, the Democrats focused almost entirely on coverage issues, while making efforts to “do no harm” with respect to costs.   They developed an imperfect bill, with many flaws, but which is a very good step forward in dealing with the issue of coverage.  On the other hand, the Republicans were not responsible in their approach to this issue.  They appealed to people’s fears in ways unbecoming of the opposition party.  They talked about “killing grandma, the loss of freedom in America, and killing babies, all of which were based on lies.  They pretended to be the defender of Medicare, which showed amazing chutzpah on their part.  They also focused on secondary issues such as complaints about the process, lack of bipartisanship, complaints about the length of the bill, and so on.  Although they did talk about serious policy issues such as tort reform and increasing taxes, the serious issues were lost in the fog of their secondary complaints and their fear mongering.

Hopefully, we can come together and address the issue of maintaining costs in a serious and productive manner.  Everyone is affected by the costs, which are increasing much faster than inflation.    Operations Research can definitely help with this issue.  O.R. has a long history of improving the efficiency of systems, including many efforts in health care.    But I think that we can do much more, especially when we work closely with those outside of our field.

Serious efforts require serious funding.   I propose that the government spend from $5 billion to $10 billion per year in research   that is dedicated to reducing the cost of health care while improving health outcomes.  This reflects a .5% to 1% proportion of our federal government’s spending on health care.   A one-time 1% sustained reduction in health care costs would pay for this program in perpetuity.   A much larger reduction is likely.

Here are some questions that the government funding agency may wish to consider?

  1. What can government do to reduce the costs of bringing an important drug to market?  If they dramatically reduce the cost of bringing a drug to market, how can they ensure that the drug companies will keep the costs of the drug reasonably low?
  2. How can hospitals be run much more efficiently?
  3. What less expensive alternatives are there to hospitals for people who do not require hospital care, but do require monitoring and help?  How effective are these alternatives?
  4. How can electronic medical records be maintained at a low cost while ensuring the right level of privacy?
  5. What medical screening tests can be developed that will dramatically reduce the costs of current testing procedures?  Here I am thinking of tests that are cheap, and have few false negatives.  People who test positive would be given the more expensive and more reliable tests.  People who test negative would need no further tests.   This would improve costs dramatically if the diseases were rare and if most test results were negative.
  6. How can we reform our tort system while ensuring that patients who receive harmful and incompetent care are compensated for losses?  How can we ensure that incompetent doctors lose their license to practice?

The list can go on and on.   Health care offers so many opportunities for improved efficiencies.  I hope we will take full advantage of these opportunities.  We certainly need to.