Once Again, It's The Prices

I've blogged periodically about the role that prices play in health care costs. The seminal 2003 Health Affairs article by Uve Reinhardt and colleagues was titled "It's the Prices, Stupid." The Wall Street Journal has made a stunning graphic from CMS data that illustrates the issue:

This shows that during each time period the impact of changes in cost per unit are larger than the impact of demographics or the impact of increased volume of services. In fairness, some increase in prices represents technologic advance (CT scans over plain x-rays).

But it's so much easier to get attention to concerns of overuse of services -- and it's so hard to get stakeholders (especially providers) to acknowledge the cost per unit problem we face. Why is that?

I think that most physicians believe that overuse and misuse happens elsewhere, so there is a sense that this problem can be addressed without any impact on me. We all know that lowering prices will have universal impact -- so it's much more comfortable not to go there.

That's why the Obama administration's push to use an independent commission to determine Medicare payments (upon which most other payments are based) is especially promising. But this problem will be solved in the health care delivery system - not merely by jiggering the prices or even the payment system. We need delivery system reform that can deliver better quality at a lower price. Our current system does deliver much-valued advances, but does this with an ever-increasing price tag.