Health Care Savings

Virginia Postrel raises an important issue about health care costs when she suggests that “new efficiencies . . . will be a one-time cut (that) will lower the spending base from which growth occurs, but . . . won’t affect the rate of increase” (Column Right, Dec. 2). By limiting her definition of efficiency to “savings in paperwork and overhead,” however, she perpetuates a common fallacy that the source of high cost is somehow external to the actual delivery of health care. The truth is that we spend more and more on health care services because we have very little idea what we are getting for our money.

The real efficiency gain from health care reform is in making us more informed and discriminating health care consumers. This educational process, including better measurement of health outcomes and the public dissemination of usable information, is the only way to reduce both the spending base and the rate of increase. It can improve our individual decisions (for example, to undergo prostate surgery or receive painful end-of-life care) and our collective ones (possibly to ban smoking or provide stronger incentives for healthful diets, etc.). Unless we learn to get better value from health care, which is the central premise of competitive health reform, the “cost caps” that Postrel considers the “real cost savings” will turn out to be meaningless.

WILLIAM M. SAGE MD, JD

Member, President’s Task Force on Health Care Reform, Los Angeles