Samuel Goldwyn
A recent article in Health Affairs tries to prove what we all knew: there were cheaper, better ways to reform healthcare but political realities got in the way. The article:
"Could We Have Covered More People At Less Cost? Technically, Yes; Politically, Probably Not", concludes using a mathematical model believe it or not that shows only a few different approaches would produce both more newly insured people and a lower cost to the government. However, these are characterized by design options that seemed political untenable, such as higher penalties, lower subsidies, or less generous Medicaid expansion.
A few means more than two, so let's say five different aproaches. What made them politically untenable was not the burden it would place on taxpayers but the fact that politicians wanted to increase government control to the fullest extent possible.
Now what if the November elections become a vote on Obamacare and a new Congress reforms the current law to reduce the cost and government control?
You can read the abstract of the article here: content.healthaffairs.org/cgi/content/abstract/29/6/1142
Meanwhile the Health IT community is still trying to convince doctors that spending billions on new systems will improve quality and reduce costs even as physician payment under Medicaid will be slashed and reporting requirements will multiply. It seems to me that the only valuable contribution health IT can really make is to allow doctors and patients to improve health by the development of personaized and predictive approaches to care and paying for that approach. The rest is simply like remodeling a restaurant to look trendy and assuming it will increase the chef's ability to produce five star meals for twice as many customers even as his salary and food budget are cut in half. So much of health It is not only beside the point but created to establish new approaches to delivering care that have nothing to do with how medicine is practiced, or should be.
