Health care reform and the deficit - it's about more than dollars and cents

As Congress hashes out the details of the budget deal made late last Friday night, my husband and I are hashing out some of our own financials from my son’s hospitalization six weeks ago. It’s quite timely, considering select lawmakers’ futile attempts to defund the Accountable Care Act during the appropriations process. I’m sure no one is surprised to read that five inpatient days at Duke Children’s are costly. To the tune of $17,255. Thankfully we have good insurance through my husband’s employer, because of that $17,000+, Blue Cross/Blue Shield “allowed” $3,265.  How’s that for collective buying power? An 81% discount!

Which brings me back to this whole federal budget/deficit turned health care debate. Again.

From the White House to members of Congress, most of the players are in agreement that, as Jay Carney said yesterday, “health care spending is a major driver of our deficit and debt problem.” And still, I have yet to hear a single member of Congress or the President talk about why costs are what they are and what they want to do about it. Lately politicians seem more concerned about making a statement for the 2012 elections – who funded Planned Parenthood, who wouldn't defund the ACA – than they are about making policy that addresses the issue of how much high quality health care really costs and what high quality care actually looks like. 

Case in point: Does a 5-day pediatric inpatient stay at one of the premier academic medical institutions in the country cost $17K or $3K? And if Duke University Health System can provide said care for $3K to some, then why don’t they charge everyone $3K? I’m fairly certain health systems like Duke's aren’t actually earning profits from the patients who cannot afford health insurance, let alone a $17K bill.  In fact, I’m sure they’re actually losing more money than the “cost” of the services they provided by the time they hire creditors and bug these folks until they declare bankruptcy and not pay their bills anyway.

And I haven’t even begun to talk about what quality health care is or the idea that, if we invested in systems and technologies that support personalized prevention, we might actually make real headway in reducing how much we as individuals  – and we as taxpayers via federal health insurance programs like Medicare, Medicaid, and SCHIP – pay for health care. This will become even more of a reality as our nation becomes unhealthier and rates of obesity and associated diseases rise in children and young adults. If folks are worried how Medicare is going to handle the Baby Boomers, they haven't seen anything yet. Wait until today's youth turn 65.

I’m all for getting the deficit under control. But when it comes to health care, we can’t continue to piecemeal solutions together without addressing the larger systemic issues: personalized chronic disease prediction and prevention beginning in childhood, coordinated care across time and providers, cost containment through quality initiatives, and of course, overhaul and transparency of pricing structures. When members of Congress stay late into Friday evening to debate and negotiate these issues, then we’ll know they’re onto something worth fighting over.