Health Care Reform Strategy Falls Short

A health care reform strategy proposed by the Commonwealth Fund Commission on a High Performance Health System relies on insurance, payment, and system reforms that would purportedly improve access, enhance quality, and save $3 trillion in costs by 2020 (if undertaken by 2010). The 122-page report, titled “The Path to a High Performance US Health System,” was released last month and is available at www.commonwealthfund.org.

Unfortunately, some of the strategies are shortsighted, ignore important realities, are not value-driven, and fail to properly evaluate the important roles of pharmacists and pharmaceuticals.

Among the proposals for reform:
• Increase Medicare payment for primary care physicians by 5% to help bolster primary care. This may be a case of too little too late. The American College of Physicians (ACP) has warned of a shortfall of 35,000 to 40,000 primary care physicians by 2025 largely because of too few physicians choosing primary care. The Commission report does not examine the benefits of expanding patient care roles for pharmacists and nurses.
• Encourage the development of patient-centered medical homes. Providers would be able to share in savings generated by improving patient outcomes. This worthwhile idea, supported by the ACP, would reward the provision of patient-centered care and improve coordination of care, especially for persons with multiple conditions.
• Mandate that all individuals have health coverage. How can this be achieved in a free society? The report doesn’t say.
• Reductions in prescription drug costs. This would be accomplished in part by having the secretary of Health and Human Services set Medicare payments for brand-name drugs for which generics were not available based on prices paid in other countries. The report notes that “manufacturers of therapeutically unique drugs effectively have a monopoly,” as if investing in research to develop patent-protected medications was somehow suspect. Such a shortsighted policy would certainly discourage drug innovation. Better would be a value-based approach in which drug therapy is evaluated in terms of its benefit in improving outcomes and reducing long-term medical costs. The judicious use of pharmaceuticals can be part of the solution to the problem of rising health care costs. Perhaps this would have been more obvious if some pharmacists had been included as members of the commission, along with the physicians, lawyers, and economists who authored the report.
• Reduce tobacco use. Proposed is a $2 increase in federal taxes on a pack of cigarettes, already heavily taxed, “to fund public health programs and insurance expansion.” There is something perverse about trying to fund health care on the backs of addicted smokers. Under a value-based disease prevention approach, smoking cessation programs would be offered at little or no cost in order to achieve longer-term savings in medical expenditures.
• Reduce obesity by establishing a new tax on sugar-sweetened soft drinks. This could fuel demand for artificially sweetened sodas, which have also been linked to obesity. More positive approaches would be to replace soda and candy bars in school vending machines with nutritious snacks and to support ongoing efforts by supermarkets to use shelf labels and staff nutritionists to help customers make wise food choices.

While everyone agrees health care reform is needed, clearly the devil is in the details. What is also clear is that pharmacists need to have a front-row seat at the table when any health care reforms are decided.