Slippery Slope Health Care Spending Topics – Mandatory vs. Discretionary, Value vs. Volume,  Consumers/physicians vs. Elites

Once you put human life in human hands, you have started on a slippery slope that knows no boundaries.

Leon Kass, MD (born 1939), American physician who considers himself a humanist

Certain slippery health care topics keep rearing their heads. How you think about them depends on how far down the human slope you have slid and on how highly you regard human decision-making.

Slippery slope topics include:

One, Mandatory  spending is authoritative, compulsory, obligatory, and ideological.  Discretionary spending is left to the discretion of health care consumers and physicians.   Of the federal budget,  62% is mandatory (Medicare, Medicaid, Social Security) and 38% is discretionary (military, domestic programs).  Mandatory spending is  an increasing part of budget; discretionary spending is declining.   Mandatory spending is ideological. Most Democrats (Obama and Senate) believe more  federal dependency will win more voters, now and in the future.

Two, Value-based spending is determined by outcomes based on data, paying only providers who practice evidence-based medicine. Volume-based spending is based on fee-for-service spending regardless of “quality” based on data.  Volume-based spending is winning because less than 1% of health care spending is now based on “quality,” and progress to pay  for “value” is still very slow, with only 10% of health plans using this criteria, though propaganda to the contrary is immense.

Three, Consumer/physician based spending  is based on what  health consumers choose to spend on out-of-pocket or out of their own money  in health savings accounts with high deductibles before they reach the deductible and what doctors they choose to visit or rely upon.  Elitist spending is based on what policy makers and government officials think is best for the consumers, and, of course, government knows best.  Consumers/physicians are winning. Small and large companies are increasingly offering only health savings account plans with high deductibles;  and consumers and physicians are increasingly bypassing  third parties through concierge and cash-only practices.   

Where You Stand on Topics Depends on...

Where one stands on these topics depends, of course, on where one sits;   who pays and what one considers to be of “value”;  and  how one thinks ideologically, i.e., whether government collectivism  or market individualism  should prevail .

In a March 25  WSJ article , “The Great Recession Has Been Followed by the Grand Illusion,” Mort Zuckerman, chairman and editor of U.S. News and World Report, put the problem in  this context:

“What the administration gives us is politics. What the country needs are constructive strategies free of ideology. But the risks of future economic shocks will multiply so long as we remain locked in a rancorous political culture with a leadership more inclined to public relations than hardheaded pragmatic recognition of what must be done to restore America's vitality.”

Tweet  To solve mandatory vs. discretionary, value vs. volume, &  consumer vs. elitist spending problems, we need less ideology and more pragmatism.