I tweeted this morning about a report of how a young medical researcher at the University of Florida demonstrated that a peanut butter test of patients experiencing cognitive decline was able to help predict Alzheimer’s Disease. This low-tech breakthrough got more retweets than usual, which prompted me to to think further about this subject – especially as it relates to Obamacare.
Given the D.C. discord over Obamacare, the government shutdown and the debt ceiling brinkmanship, it was hard not to consider our need in America to explore such low-tech solutions more aggressively. As silly, dangerous, and embarrassing as are these Tea Party histrionics – bringing us political theater on par with any banana republic Woody Allen ever imagined – we do have a long-term debt problem that needs addressing.
Republicans like to call this “entitlement” spending, meaning money spent largely on Medicare and Social Security. This, of course, has been central to their decades-long push-back on America’s safety net that dates back to FDR’s New Deal. It – along with Social Security, the G.I. Bill, Medicare, Medicaid, Obamacare and similar measures that built America’s middle class – have consistently been derided by Republicans, John Birchers and now Tea Partiers as “socialism” and “communist” plots.
The fact that the majority of Americans reject this extremist view – and are intelligent enough to recognize our economy’s need for a vibrant middle class to, you know, consume stuff – doesn’t negate our need to pursue responsible measures to rein in our debt spending. It’s how we do so where the rubber meets the road.
Is It Really a Medicare Problem?
Social Security is relatively sound for decades to come. Its financial stability can be further improved with modest adjustments that fall far short of draconian.
Medicare, however, is a more difficult proposition because of the underlying medical spending that is driving its costs higher at a far faster pace than for Social Security, where cost-of-living increases are rare and a fraction of the increases in our medical spending. Proposed Medicare reforms, however, fail to address this underlying spending and merely alleviate the government’s burden, and at the expense of Medicare beneficiaries/patients.
The underlying problem of uncontrolled healthcare spending – of which Medicare budget projections are merely a symptom – is a bigger and more complex problem that Obamacare improves only marginally. The growing share of the American economy devoted to healthcare – fueled by pricing that’s twice that of other developed countries (see “A Nation of Suckers“) – literally threatens to bankrupt the country, and its citizenry, if we don’t figure out how to re-engineer our fragmented and grossly inefficient healthcare system. Obamacare is but a down payment on the kind of systemic healthcare reform needed.
The Accountable Care Organizations (ACOs) that Obamacare encourages will help, but not on the scale or timeline required. And because of the financial risks they’re required to assume, only large integrated delivery systems are likely to succeed as ACOs. And large healthcare delivery systems have generally proven to use their market heft as leverage to exact higher prices from insurers. This, of course, will mitigate any potential cost savings they might otherwise produce – which so far have been modest in any event.
Medicare’s Not the Problem
Before getting back to the peanut butter, a couple of caveats apply. First is that healthcare spending has been tapering off of late. More precisely, the growth in healthcare spending has been tapering off – it’s not like we’re actually spending less on healthcare. Indeed, what we’re spending on healthcare continues to grow at twice the rate of the rest of the economy, but it was growing at three times that rate.
There are multiple explanations for this pullback in our rate of spending growth for healthcare. Some of it’s due to slowing patient demand attributable to an economy that still hasn’t fully recovered from its near-recession lows following the crash of 2008, especially for those struggling to make ends meet.
Some of it’s attributable to pricing pressure from Medicare and Medicaid, as well as private payers repositioning themselves in the aftermath of the recession and in anticipation of Obamacare. And some of it’s attributable to Obamacare itself as both insurers and providers tighten their belts in anticipation of a more cost-conscious medical regimen going forward.
The other caveat is that, as this tempering demonstrates, Medicare is a more cost-effective purchaser of medical services than private insurers (see “The Problem With Medicare Isn’t Medicare“). So focusing solely on Medicare reforms to reduce the government’s financial burden – when Medicare so outperforms the private sector in controlling costs – is a bit like going after those who don’t drive cars to reduce auto accidents.
Medicare’s not the problem, healthcare spending is the problem – and fixing that requires regulation, something that’s anathema to Republicans who are pushing for Medicare reforms. These so-called Medicare “reforms” are designed to shift the burden for poorly-controlled healthcare spending from the government to patients/consumers. The focus instead should be on better controlling our healthcare spending so there’s less of a financial burden for all of us, not just the government.
Republican’s “free-market” solutions don’t address this core problem because they don’t really want to control, much less lower, medical spending that benefits their corporate sponsors. Dumping everything into an unregulated free market for healthcare – something no other developed country has done and for which there’s zero evidence of effectiveness (just theory) – is far more likely to exacerbate our healthcare spending by removing the existing regulatory constraints on abusive medical practices (see Our Healthcare Sucks for a litany of such abuses).
Remember, as I document in the book, healthcare is the most corrupt industry in America – and by a mile (with four times the fraud settlements with the federal government as all other industries combined). Removing regulatory constraints on such behavior would be the height of governing irresponsibility – not unlike threatening to default on the federal debt.
So What’s This Got to Do with Peanut Butter?
The peanut butter breakthrough is just an example of how many of our healthcare needs don’t require high-tech solutions. The challenge in managing chronic diseases that account for 75% of our healthcare spending will often be better met with low-tech/high-touch solutions.
Simply better communicating and following-up with chronic disease patients to keep them on track in their treatment regimens has been shown to be superior to adding more drugs to their regimen – something I also discuss in the book.
We’re so culturally addicted to high-tech breakthroughs, however, that we lose sight of the obvious and common-sense answers that are often right before our eyes.
And for those who think we’re far too advanced in America – that the greatest nation on earth shouldn’t have to stoop to such measures – well, we’re already behaving politically like a banana republic, so get over yourself. And in case you hadn’t noticed, much of America is effectively a developing country. John Edwards may have proven himself a putz, but he was right about the “Two Americas” thing.
And if Obamacare is to elevate healthcare for its developing population, there are worse ways to do it than peanut butter.