The Blog

Define 'Waste, Fraud, and Abuse,' Mr. President

It would be helpful to know which programs would be cut under Obamacare.

12:00 AM, Sep 30, 2009 • By STANLEY GOLDFARB
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Why are prices so high at academic health centers? These institutions use the proceeds from their clinical activities to underwrite medical education costs and research activities. The latter are very costly but have obviously yielded enormous benefits to the U.S. Also, the academic medical centers have enormous malpractice insurance costs as well as the burden of caring for the uninsured and the poorest segments of the population.

The next question is whether this type of access is wasteful? Sure it is, unless you are the one that needs it. The touted clinical effectiveness research initiative found in both HR3200 and the "America's Healthy Future Act of 2009", better known as the Baucus bill, will aim to identify who exactly might benefit from which care. But the likelihood that each individual case will fit into a model system determined by assessment of the information in large computer data bases is pretty slim. Worth doing no doubt, but believing that it will dramatically lower health care costs is an example of hope overtaking reality.

Can we lower the cost of health care by 50 percent and achieve the type of care found in Canada, for example? Sure we can. All we need to do is close down all those cardiac surgery programs and community cancer centers that have sprung up around every large city and consolidate organ transplant programs and complex surgeries requiring enormously expensive surgical robots to a few hospitals in each city. We also should close down physician-owned, free-standing radiologic units that allow physicians to refer patients to their own facilities. Also, prevent self-referral to specialists without a primary care physician approval and penalize the primary if he sends too many patients to specialists. Put physicians and hospitals on a strict budget and do not allow them to provide any non-emergent care if the budget is exceeded towards the end of the fiscal year.

Are there less draconian ways to cut health care spending? Perhaps, but the draconian ones will work best. Is that what we want?

Stanley Goldfarb MD is associate dean of clinical education at the University of Pennsylvania School of Medicine and a nephrologist.