Carroll County Times

Mitch Edelman: Solutions to health care costs exist

July was tough for me. I spent most of it preparing for, having, and recovering from two total hip replacements.
If I had my druthers, I druther not have needed these surgeries, but that wasn't how life turned out. As it is, I am grateful these two procedures were available to me, and that I have medical insurance to cover their costs, both Medicare and a supplemental policy. I am pretty lucky.
Having this surgery is a no-brainer. Why live with pain and restricted mobility, especially when the surgery increases my chances of living a longer, healthier life? A study of more than 20,000 Medicare patients with long-term hip arthritis shows that hip surgery cuts the risk of dying. You are twice as likely to survive the seven-year period following surgery than you are without it.
Over the seven-year post-op period, Medicare costs for those having surgery are about $6,400 more, but the longer you live after surgery, the less the total cost compared to those who don't. So in a sense, the surgery is a bargain, as I plan to be here a while.
As we age, medical costs increase exponentially. Cost containment of Medicare and Medicaid, as well as private health coverage is essential. The Affordable Care Act helps. This year's Medicare Trustees' report projects a two-year delay, until 2026, before funds run out.
This less than cheerful news emphasizes the urgent need to reduce the growth rate for health-care expenditures in both the private and public sectors.
Republican attempts to repeal Obamacare are foolish and futile, since we need to find more, better and different ways to cap costs, not fewer.
In a free market, you can shop around for the best value, but not for health coverage. An article in the March 2013 Journal of the American Medical Association shows a range of costs of $10,000 to $125,000 for hip replacements (Medicare usually pays between $10,000 and $25,000 for this procedure). But most hospitals don't actually know the total cost, so you can't comparison shop. This opacity created "medical tourism" to surgery centers across the world, where surgeries cost a fraction of what they do here. Whether their quality is comparable to say, Johns Hopkins, is debatable.
Sane, sensible ways to manage costs exist and are ignored, mostly for political purposes. According to the Congressional Budget Office, the Veterans Administration, which negotiates prescription prices, pays about 42 percent of average Medicare prices for prescriptions. For the top 20 drugs used by seniors, Medicare prescription costs are about 48.2 pecent, or around $260 higher than the VA's costs. CBO estimated that negotiating prices would save taxpayers $50 billion per year, or about 3/5 of sequestration's damaging cuts, with zero reduction in health.
Congressional Republicans, though, would rather protect pharmaceutical corporate donors than the economy.
Defensive medicine, the practice of performing medically unnecessary tests to inoculate physicians against lawsuits, adds about $45.6 billion annually to the cost of health coverage, according to research recently conducted at the Harvard School of Public Health. Democrats might help save a large part of the estimated 2.4 percent of the health-care budget by passing tort reform legislation to cut back on frivolous lawsuits. Former Democratic Sen. Bill Bradley has long been an advocate of combining tort reform with expanded health coverage, a bargain that might strengthen Obamacare and reduce costs across the board.
Even though it faces massive political opposition, $400 billion in administrative costs could be saved with a single-payer system. The Grand Junction Co. health care system is an example of a locally-administered program that maintains better-than-average health coverage at below-average cost.
There are many ways to provide excellent health care while keeping costs from breaking the bank. All it takes is for our representatives to put the country's physical and financial health ahead of politics.