There is some research that we know we just shouldn’t bother reading, but we can’t resist, even though we know it will leave us both chortling and annoyed at its vacuous content. A missive from the Brookings Institute called “Bending the Curve: Person-Centered Health Care Reform” fits the bill perfectly. Anytime you can throw at least two buzz phrases in a title, you know you have a winner. (Brookings Report) The authors claim full implementation of their approach will save $1 trillion over 20 years, or is $20 over a trillion years? The usual suspects are rounded up and grilled intensively–change how we pay providers, only pay for quality and outcomes, coordinate care better, get people involved in their care, create benefit designs that encourage use of “valuable” and “appropriate” services. It is not that these and other ideas are not worth trying or don’t have some utility; it is that they trip so lightly off the tongue, with no thought to what is really involved in execution. And they do nothing to address the very fundamental issue–we have disconnected poor health behaviors and use of care from their cost. We are proposing to engineer a massive expansion of Medicaid, which provides gold-plated coverage, often going to individuals who do absolutely nothing to either get and stay healthy or to be good consumers of health care services. And why should they, its all free to them. We get tired of pointing out the obvious. As much as possible, people should pay out of pocket the full cost of their care and/or their care coverage. People who are subsidized by other people should have to use public care resources, such as community health centers, unless they aren’t available and should have to engage in healthy behaviors or they shouldn’t be covered. When responsibility is encouraged, miraculously cost growth will slow down and overall health status will improve.
