The following editorial appeared in the St. Louis Post-Dispatch on Tuesday, Dec. 30:

Whenever the subject of universal health care is raised – and it will be raised by the incoming Obama administration and Congress next year – the first question always is how to pay for it.

Americans spent more than $2.5 trillion on health care last year; that’s a 25 followed by 11 zeroes. And that was with 46 million of us without any health insurance. How much more would the nation have to spend to cover the uninsured?

One leading researcher says the answer is zero – if we improve the health system’s efficiency.

If every doctor and hospital in the United States managed patient care as well as the prestigious Mayo Clinic manages its patients, the study found, the nation could save a staggering $750 billion a year in health care costs -about $2,500 for every man, woman and child in the country. That would be more than enough to pay for universal health care. And the Mayo Clinic isn’t exactly known for substandard care.

This declaration might be dismissed as wishful thinking if it weren’t coming from researcher Dr. John E. Wennberg, the influential founder of the Dartmouth Atlas. It tracks regional variations in medical care, cost and quality.

Dr. Wennberg’s research has shown that, on average, care provided to elderly Medicare patients in Miami costs twice as much per person as care provided to similar patients in Minneapolis. Yet all the additional spending in Miami produces no increase in the number of years the patients live or the quality of the rest of their lives.

For more than three decades, Dr. Wennberg has studied the different ways that different doctors treat the same medical condition. Not all treatments are equally effective, yet variations persist.

Over the years, Dr. Wennberg’s ground-breaking research has uncovered some surprising results. For example, spending more on health care and getting more of it does not ensure longer or healthier lives. He also has confirmed that supply sometimes creates demand: The more hospital beds or CT scanners there are in a certain area, for example, the more likely it is that doctors will send patients to the hospital and prescribe CT scans.

Dr. Wennberg adds that the more specialists in a given region, the more frequently they are used. That results in higher costs, but it doesn’t necessarily produce better outcomes.

In a new report, Dr. Wennberg and his Dartmouth colleagues recommend organizing care along the lines practiced at the Mayo Clinic and a number of other high-quality health systems. Mayo and comparable operations have clear guidelines about when and where to refer patients to specialists and admit them to hospitals and when to order sophisticated tests and treatments.

The care too many Americans receive is poorly organized and uncoordinated, Dr. Wennberg and other experts say. Some effective initial treatments are underused, and too much high-intensity care is delivered later.

Changing these patterns probably would require changing how doctors and hospitals are paid. Instead of receiving fees for treating illness, they should be paid to keep patients healthy – for providing recommended health screenings and counseling patients on diet and quitting smoking and other unhealthy behaviors.

Dr. Wennberg also recommends continuing research into the most effective treatments for diseases and conditions so that the care provided actually accomplishes the goal.

The good news, most experts agree, is that making the health care system more efficient would result in enormous savings – enough to cover every American. The bad news is that, unless we start changing soon, we risk the collapse of the health system on which we all depend.


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