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Thursday, February 02, 2006

George W and the Cost of Care

In his 2006 State of the Union address, President Bush put his finger on a central dilemma faced by those who would do something about the cost of health care.

Here is what he said:

“For all Americans, we must confront the rising cost of care, strengthen the doctor-patient relationship, and help people afford the insurance coverage they need.”

What the President seems not to realize is that the current strength of the doctor-patient relationship is prominent among the major barriers standing in the way of doing something about the cost of providing care.

Modern health care depends on systems. The way to get cost under control is to make those systems more efficient and the way to do that is to manage them.

For example, the evidence indicates that if patients with congestive heart failure are treated in accordance with a certain standard, outcomes will be better and costs will be lower. Health care managers are making efforts to get doctors to adhere to that standard. Those efforts are often resisted because they are seen as interfering in; i.e., weakening, the doctor-patient relationship.

So, Mr. President, you can either confront the rising cost of care or you can strengthen the doctor-patient relationship. But you can’t do both.

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