There was a brief flurry of debate over the past couple weeks concerning the Bush health plan, though that seems to have died down for the moment.  For a taste of the debate, check out the comment marathon following Matthew Holt’s post on the Bush health care "plan" in the State of the Union address over at The Health Care Blog.

Whenever issues of health care cost and affordability come up, someone always notes that European countries provide better care at lower cost, and someone else always says, so what, that’s not relevant, and maybe not even true. 

Well, I’ll jump into the fray, but not alone — The Commonwealth Fund’s Commission for a High-Performance Health Care System released a report last month entitled Slowing the Growth of U.S. Health Care Expenditures: What Are the Options?  The report led with a look at growth in health care costs over the past 25 years in the U.S. and in Europe — guess who’s ahead.  (Check out the graphic — click to enlarge.) 

The summary of the report reads as follows:

The U.S. is an outlier in the level of health care spending, with far higher spending on health care per capita than other countries. There is ample evidence that the U.S. does not obtain value for money spent, and that there are wide variations in health care spending across the U.S. that do not contribute to better health outcomes.

Substantial net gains in quality at lower costs are potentially achievable from realigning payment incentives to reward efficient and high-quality care, reshaping market incentives to reward value-driven health care, improving administrative efficiency, and redesigning care delivery systems to enhance primary care. Such reforms would be founded on enhanced information about the quality and cost-effectiveness of care and appropriate deployment of modern information technology. Fragmented policies that focus on one aspect of care or shift expenditures from one payer source to another, or from one sector to another, will not result in transformation of the health care system to yield high performance.

There is a compelling need for a coherent public and private sector strategy, with all parties working in concert toward agreed-upon health system aims. Such a strategy should place high priority on policies and practices that have the potential to move our nation toward benchmark levels of performance on access, quality, and efficiency, so that the U.S. health system could achieve commensurate value for the significant resources it commands.

The report lays out some background and a framework for thinking about how to slow the growth in costs, and is worth reading.

It is human nature to like to hear from folks who agree with us — and so I’ll close by plucking out one bit of this report that I liked reading:

Again and again, studies have found that high cost-sharing, including deductibles, leads patients—particularly those with low or modest incomes—to forgo both essential and more discretionary care.

So we need a new way of thinking about this problem.  The flavor of the month seems to be value-based, or value-driven health benefit design.  Check out the discussion in the report.

David Harlow