No 'painless' way to cut U.S. health costs: experts

The United States has the world's most expensive healthcare system and President Barack Obama says he believes he can help pay for reform by cutting costs.

But in an analysis published in the journal Annals of Internal Medicine, healthcare policy experts expressed doubt that certain policies embraced by the president, even if they are worthwhile for other reasons, will cut healthcare costs. “The problem as a country is we're in love with the painless solutions. And these things aren't going to work,” Jonathan Oberlander of the University of North Carolina School of Medicine said in a telephone interview.

Last month Obama signed a bill to spend about $20 billion to encourage the use of health information technology, such as electronic medical records and electronic prescribing of drugs, compare how well different types of medical treatment work, and fund disease prevention efforts.

But there is little evidence such measures will control healthcare costs, according to Oberlander and colleagues Theodore Marmor of Yale University and Joseph White of Case Western Reserve University.

They pointed out that the nonpartisan Congressional Budget Office disputes claims of sizable savings from moving to electronic medical records instead of paper records. A team at Johns Hopkins University countered this in January with a study showing that hospitals that use healthcare information technology cut costs significantly and saved lives.

Oberlander's group also said comparative effectiveness research looking at, for example, whether one drug works better than another, is not guaranteed to significantly lower costs. Savings depend on whether insurers and doctors act on the findings.

They said previous research has shown that prevention efforts usually add to medical spending, and that prevention measures that emphasize medical services, such as annual doctor visits and disease screening, can be costly.

Obama's presidential campaign last year proposed creating a public health insurance program for people under age 65 before they are eligible for Medicare that Americans could volunteer to enter if they do not have or want other health insurance.

Oberlander said such a program could help set limits on medical care prices, but added that getting lawmakers to support this new program would be politically difficult.

“Effective cost control requires strong government leadership to set targets or caps for spending in the various sectors of medical care (hospital, pharmaceutical and physicians), either directly or through insurers,” Oberlander and colleagues wrote.

“The extent of savings would partly depend on the size of the public plan's enrollment; a larger plan would have more purchasing power to control costs. Savings would, of course, also depend on the political willingness to reduce payments to medical providers,” they wrote.

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