Home Blog Mr. President: hospitalists and health care costs

Mr. President: hospitalists and health care costs

January 2009

For anyone concerned about the state of health care or, for that matter, the state of our economy, a good primer would include the recent NEJM Perspective titled “Market-Based Failure: A Second Opinion on U.S. Health Care Costs.”

The piece presents an overview of the staggering cost of health care in this country. To wit: In 2006, health care spending exceeded $2.1 trillion dollars, more than $7,000 per person. Health care costs as a percentage of the gross domestic product are now 16%, on their way to 20% within the next seven years.

Any serious attempt to control health care costs must rely on disease prevention. The author of the NEJM piece argues that improving basic preventive care measures adds up to big health care savings.

The author also states that, as yet, such efforts have not been maximized because of skewed economic drivers within our health care system. He points to the high administrative costs and profit-seeking of private insurers as two examples. To be sure, the move to universalize health care is getting more attention. One of the premises of the movement toward universal health care is the potential ability to improve preventive medicine, with the assumption that a healthier population will cost less for all of us.

Obesity is expensive, and the obesity epidemic represents one of the biggest public health failures to date. Experts now estimate that 30% of the U.S. population is obese, a phenomenal increase over just the last 10 years.

As a result, many politicians are staking a claim that curbing obesity will save us untold future dollars. As now President Obama stated during one of the Democratic debates, “it’s estimated if we went back to the obesity rates that existed in 1980, that would save the Medicare system a trillion dollars.”

Well, not so fast, argues a recent and fascinating article published in the Public Library of Science.

The authors, who simulated the costs of people who were obese vs. those who were smokers and others who were “health living,” did find that obesity prevention led to a decrease in obesity-related disease. However, those savings were offset by the costs incurred for non-obesity related diseases that affect people during the extra years of life they get to enjoy–because they don’t die from obesity.

Put another way: If you do not die of an MI caused by obesity-induced coronary disease while you’re relatively young, you will burden the health care system down the road with comorbidities related to, say, advanced Alzheimer’s.

So what does this have to do with hospitalist medicine? There is no question that hospitalists improve utilization of health care dollars, a fact that has been borne out in many studies to date. And there is no question that our value in the overhaul of health care becomes more important by the day.

Our significance will become only more important as the number of people age 65 and older continues to grow. In 2000, this demographic totaled 35 million, a number that will more than double to 71 million by 2030. If politicians are looking to save health care dollars–and even though the rhetoric of the campaign is now a distant memory, it is clear that they still most certainly are–hospitalists might be a more sure bet than curbing the obesity epidemic.

This does not imply that our country’s ever expanding waist line does not deserve attention, only that its importance in curing our health care economic crisis, as suggested in the PLoS study, may not be as important as one might believe.

Now, I don’t mean for this blog to be an exercise in self-adulation (never!). But I do believe that all of us recognize at least two things: 1) Any specialty that contains costs will grow rapidly, which is abundantly clear to date; and 2) There will always be increasing pressure to contain costs once we demonstrate our proficiency at doing so.

When I wrote the first draft of this blog, the presidential election was still very much in doubt. Now we have a new president.

Until President Obama’s HHS designee, Tom Daschle, bowed out, he wanted to establish a Federal Health Board, which would function as an independent entity like the Federal Reserve. This board would “reduce or deny payment for new drugs and procedures that aren’t as effective as current ones.” I suspect the board, if the idea is retained by whoever is Mr. Daschle’s successor, would also function to determine the future allocation of payments to physicians based on their efficacy at controlling health care costs.

It should be obvious that we may be among the few specialties that offer a viable, long-term solution to containing the runaway train that hospital health care spending has become. Here’s to hoping that President Obama and the new head of HHS recognize our importance when they attempt to, and please excuse the bad pun, trim the fat that currently exists in our health care system.