The cost of health insurance is rising. Again. High premiums, co-pays and cost sharing are hurting businesses and their employees. Insurers are pulling out of the ACA health insurance market in New Jersey and around the nation.
U.S. health care spending, meanwhile, has reached $3.0 trillion, taking money away from housing, education, social services and support of our bridges and roads. Health care spending now accounts for 17.5 percent of our Gross Domestic Product. Some experts say the cost will be $4.8 trillion in 2021, or one-fifth of our GDP.
You get the picture.
I don’t know of any serious person in the world of health care who does not believe we need to rein in costs.
But does that mean we have to deny patients with Hepatitis C valuable, but highly expense, new treatments? Do we stop paying for the high-priced cancer treatments that can save lives?
We do not want to cut care that has value to patients — and we don’t have to. What we need to cut are tests, procedures, drugs, surgeries and hospitalizations that do not help, and may even harm, patients. Or, care that patients may not want. Experts say that at least one third of U.S. health care spending is wasteful.
All of us, as patients or health care providers, must be good stewards of our health care dollars. The best guide on that path, in my opinion, is Choosing Wisely, an initiative by the American Board of Internal Medicine Foundation. Choosing Wisely aims to promote conversations between clinicians and patients by helping patients choose care that is:
- Supported by evidence
- Not duplicative of other tests or procedures already received
- Free from harm
- Truly necessary
I do not know anyone who would not want to check all those boxes before enduring a test or procedure or taking a medication. Yet too often patients are given chemotherapy that will not prolong their lives or improve the quality of their lives. Prescriptions for antibiotics are given when there is no indication they will work. Late-stage Alzheimer’s patients are put on feeding tubes with no evidence they help and with many risks, such as bleeding, infection, nausea and vomiting.
Choosing Wisely examines intervention after intervention, such as lung Ct scans for smokers, continuous fetal heart monitoring during delivery, urine tests for nursing home patients, implantable cardioverter-defibrillators for people with heart disease, and whole body scans for cancer.
The lists are comprehensive and issued by the medical societies from each specialty area of practice. Each “Choosing Wisely” list clearly explains the interventions and why they may not be the best course for many people. Reading through the recommendations I was stunned at how much of our medicine actually harms people. The information created by the initiative, started in 2012, is easy to understand, objective and evidence-based. You can access the list here.
As we try to keep insurers in our state and increase competition in the ACA market, or look to reduce the cost of our state-funded health benefit plans and Medicaid program, let’s choose wisely and think wisely about what we cover and how we spend our precious resources. Let’s cut waste before we have to tell patients who need costly but necessary interventions there’s no money left to save their lives.