The Patient's Role

But here's where things get muddy. What if people do make an earnest attempt to get healthy and embrace wellness? If the goal of healthcare reform is to expand coverage so that more people can see physicians for preventive medicine, that means more imaging and more tests, some of which will be ineffective and expensive. And if universal coverage actually comes to pass, the addition of 40 million people to the ranks of the insured could gravely tax a healthcare delivery system that is already stretched to bursting.

This is not addressed in any of the three main healthcare reform bills that Congress considers this summer ("Comparing the Three Main Health Reform Bills," HealthLeaders Media Daily News & Analysis, Aug. 4). There is plenty of language about expanding coverage, removing prohibitions against preexisting conditions, eliminating copays for preventive care, capping out-of-pocket expenses, and the employer pay-or-play mandate. These are noble measures, to be sure, all of which have the great potential to expand healthcare to millions and thus expand use of expensive medical services, not curtail it.

We are told that healthcare reform will address overuse, that electronic health records and evidence-based medicine will winnow out ineffective tests and procedures, saving money, time, and resources. But that is years away, at best. So, back to the healthcare consumer.

Golden, CO-based HealthGrades conducted a recent study that found huge state-by-state variations in the costs and outcomes of bariatric surgeries. Rick May, MD, a senior physician at HealthGrades and an author of the study, says it provides a good example of the "twisted market" that is driving elective medicine—namely, the lack of incentive among insured consumers to keep costs low. ("Bariatric Study Raises Larger Issues of Healthcare Costs Quality and Consumerism," HealthLeaders Media Daily News & Analysis, Aug. 3.)

What incentive, May asks, does the insured healthcare consumer have to keep healthcare costs low if his insurance plan is picking up 90% of the cost? It's an excellent question. Unfortunately, it's not being asked—nor answered—by the people in Washington who are drafting the legislation for reform.