There has been much ado in the news about health care reform, health coverage reform, health payment reform and clinical practice reform. All are tangential references to the real elephant in the room — health cost reform.
Why has the elephant grown so large? Is there a combination of diet and exercise that can help our elephant become slim and trim?
Your perspective on the reasons and solutions depends on the part of the elephant closest to you. If near the poor, unhealthy, uninsured patient part of the elephant, mandatory affordable health insurance for all is the ticket. If near the insurer part of the elephant, your focus is reducing the discretionary price-gouging, cost-shifting and wasteful choices of consumers and providers. If near the employer and plan sponsor part, you may wonder whether replacing employees with robots may be the better way to avoid health costs. Those near the care and treatment part fuss about the onerous rules, processes and habits that interfere with engaging patients in achieving and maintaining better health. Those near the social and mental health part of the elephant see a need for allocating more resources to prevention and education than to rescue.
Everybody sees that the big elephant is crowding out other important things desired for the room, such as wage increases, job protection, life choices, equitable access and security.
All parts of the elephant need to shrink to a more normal size. The March 2013 Time Magazine article by Steven Brill - Bitter Pill, Why Medical Bills Are Killing Us describes many wasteful practices that perhaps could be curtailed. But where do we start? Whose ox gets gored?
We Americans tend to prefer "nudges" to affect sustained change rather than voting for more government mandates typical in other lower-cost countries. Therefore, perhaps we should leverage all available resources to favorably influence the choices of health care users and providers to affordably improve our health.
We need to seek first to understand and prioritize what is most important.