The President used tonight’s State of the Union address to praise three very American values: competency, efficiency, and affordability. The old joke about how in heaven it’s the Americans who are in charge of the plumbing resonates with something we know about ourselves — we are an immensely practical people.
Looking for an example of our competency in health care matters? President Obama extolled our reputation as biotechnology innovators. Looking for an example of our efficiency in health care matters? President Obama extolled the marvels of electronic medical records through the Veterans Administration. But if you are looking for an example of American engineered affordability in health care matters, you may have to keep looking for a while. We are by far and away the high price leader on per capita spending on health care. And we do not garner good value for what we spend. We are middling, at best, on some key health outcome indicators.
To be fair, President Obama did reference the need to promote consumer side affordability, touting the beginning of the closing of the Medicare Part D doughnut hole. What was missing was any specific word on how to promote more affordable costs beyond reconsidering tort reform. Medical malpractice tort reform ought to be considered for any number of reasons, not the least of which is that it is a terribly ineffective compensation system for those harmed by medical error, but it is not a key cost driver in health care inflation.
Our key health care inflation cost drivers involve things like our failure to reward efficiency in integrated care delivery, our failure to demand and deliver evidence based medicine, and our failure to plan the roll out of new health care technology. Our failures are also those of competency, efficiency, and affordability.