The Obama Administration's Options for Health Care Cost Control: Hope Versus Reality

Abstract

Controlling the costs of medical care has long been an elusive goal in U.S. health policy. This article examines the options for health care cost control under the Obama administration. The authors argue that the administration's approach to health reform offers some potential for cost control but also embraces many strategies that are not likely to be successful. Lessons the United States can learn from other countries' experiences in constraining medical care spending are then explored.

The healthcare system in Saudi Arabia: How can we best move forward with funding to protect equitable and accessible care for all?

“…[53] In fact, there are moves in progress to address this, with the introduction of Obamacare, which seeks to improve the current system. [10] There remain a huge swathe of critics of these changes to policy, however, and it would seem that more overhauls may occur in the near future to address the growing burden that health is placing on the American budget while making healthcare affordable and accessible for all. [54] 2.2.4 Public private partnerships An alternative to privatisation of healthcare and subsequent use of insurance schemes is the use of public private partnerships (PPPs).…”

“…[9] However, other nations which have a well-established reliance on a similar approach have still experienced escalating healthcare costs. [10] Experts have expressed concern with regards to the likely outcomes that will be seen if the current proposals continue with implementation. [1] Moreover, there is a lack of research into whether alternative options would provide a better solution.…”

From HMOs to ACOs: The Quest for the Holy Grail in U.S. Health Policy

“…Indeed, because panaceas promise to moderate spending by reducing ineffective care, improving coordination, and keeping people healthy, such policies offer the prospect of painless cost control. 5 That is powerfully alluring for politicians who want to avoid the conflict associated with policies such as imposing budgetary caps, limiting payments, restricting the availability of services, or cutting benefits. Further, if new organizations can be created to handle the task of making the difficult choices, or if new payment tools can be adopted that automatically unleash the right incentives, politicians can avoid blame for unpopular decisions.…”

“…Restraining spending requires reducing the income of health care providers who historically have been effective at resisting robust cost controls. 8 In addition, government measures to reduce spending growth invite charges of rationing that tap into many Americans' distrust of government-recall the hysteria over mythical "death panels" during the 2009-2010 health care reform debate. And America's fragmented political institutions give opponents multiple chances to defeat or weaken proposals to limit spending.…”

ESRD as a Window into America's Cost Crisis in Health Care

“…Recognition that these trends are unsustainable has motivated political action to reform America's health care system to achieve more effective cost control. 8,9 Although spending on care of patients with ESRD represents only a fraction of total health care costs, the rapid growth in spending on ESRD care, illustrated in Figure 1A, represents in microcosm the escalating costs of the overall health care system. The rapidly escalating total cost of ESRD is partly attributable to the growth of the prevalent ESRD population in the United States, as seen in Figure 1B.…”