I write from the perspective of a physician who has followed the curve of excess costs from the days (1950s) when there was very little money in medicine. On my first posting, I trace the sequence of events that led to the present state of high costs, large variations in use, and large errors and harm.
WHAT TO DO? HERE IS A STARTER SUGGESTION:
Medicare has clinical and cost data across the country. Why not use it to curb futile and unnecessary costs?
1.Track hospital mortality rates for costly procedures and drop hospitals who exceed the death rates by a certain margin. There are still hospitals for excessive mortality in many areas. Drop them from medicare for those procedures.
2.There are many hospitals doing procedures that are too small in number to be good at the procedures. There is a minimum number of operations that need to be done; below that number it is unsafe. Drop those small volume hospitals from medicare for those procedures.
3. The huge amount of money spent in the last 6 months of life can be curbed. Define what is futile care in the elderly (I am in that age group and do not want futile care) and refuse to reimburse futile efforts.
4. Move patients who are receiving futile care into hospice and palliative care.
These suggestions would save money but will need congressional backing. Medicare already has the data. USE IT! This will save money and improve the overal health of the population.