Nation’s top health official vows attack on wasteful spending

June 25--The nation's top health-policy official told an audience in San Diego on Saturday that he's committed to wringing out wasteful spending -- regardless of what happens with efforts by President Donald Trump and the GOP-led Congress to reshape Obamacare.

The speech by Dr. Tom Price, the U.S. secretary of Health and Human Services, came two days after a select group of Republicans in the Senate released a bill that would eliminate the Affordable Care Act's requirement for most people to buy health insurance or pay a fine, significantly roll back the expansion of Medicaid coverage for the poor (called Medi-Cal in California) and end the increased taxes on affluent Americans that have underwritten much of Obamacare's spending.

Like its counterpart legislation in the House, the Senate package would maintain federal subsidies for Obamacare insurance premiums -- including policies sold through the Covered California health exchange -- for two more years. So Obamacare enrollees wouldn't see any notable financial shifts in the immediate future.

That has hardly stopped the two bills from stoking impassioned speeches in Congress, protests in cities across the country and page after after of postings on Facebook, Twitter, Reddit and other online forums.

Divisive issues include whether patients with pre-existing medical conditions would have to pay more money for insurance compared with people who have a clean health history; whether maternity care, including abortions, and some other services would be covered; and how much the nation's uninsured ranks would swell again once the subsidies are halted.

The House passed its measure in May. Senate Majority Leader Mitch McConnell, R-Kentucky, said he wants a vote on the Senate version before Independence Day. It's unclear whether that will happen because several of his fellow Republicans have cited various reasons for why they can't support the legislation -- and McConnell can afford to have only two GOP lawmakers vote no.

In Washington, D.C., and beyond, Democratic Party leaders, a broad range of churches, major medical organizations and insurance companies have overwhelmingly criticized both bills, which they predict would hurt tens of millions of seniors and low-income Americans. In contrast, key GOP figures, the U.S. Chamber of Commerce and a range of conservative groups have said Obamacare must be altered because its financial costs far exceed its benefits.

Polls show that most Americans simply want decent health insurance coverage at affordable prices.

The Affordable Care Act hasn't aggressively targeted the root factors that have caused America's health-care system to be the world's most expensive. Currently, the House and Senate replacement bills also focus more on the mechanics of providing health insurance than on reducing the nation's overall health-care spending.

During his short keynote address to the California Association of Physician Groups on Saturday at the Manchester Grand Hyatt hotel, Price didn't dwell on the legislative controversy. Instead, he placed an emphasis on cost controls.

Although many in the audience are opposed to the House and Senate replacement bills, they gave Price a standing ovation after his remarks. Price had repeatedly told the conference-goers that his department is in "full receiving mode" for their suggestions. He also repeatedly said doctors should be driving health-care policy, especially as it pertains to the ongoing quest to reduce costs without eroding quality.

"You're the ones that are the true source of ingenuity and innovation that have made our health-care system the envy of the world in so many, many ways," Price said.

Don Crane, chief executive of the California Association of Physician Groups, said the biggest potential for fundamental change lies in the way doctors are paid. Removing the incentive for doctors to conduct more medical procedures because they get paid for each one can go a long way toward eliminating the estimated 30 percent waste in the country's health-care system, he said.

"Our argument is that if you have the right model, scaled across the country, you would achieve so much savings that coverage would become a much easier matter," Crane said.

Some experts have pushed for Medicare and private insurers to pay a fixed dollar amount for all care related to a disease or other condition -- say, a knee replacement or a brain tumor surgery -- contending that it would force hospitals, rehabilitation facilities and outpatient doctor's groups to collaborate more so they can better stress preventive care and thus save money.

Other experts have advocated for robust, centralized government control over the pricing of prescription drugs, hospital services, outpatient care and the rest of the medical spectrum.

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U.S. health-care expenditures: total figures

(not adjusted for inflation)

1960: $27.2 billion

1970: $74.6 billion

1980: $255.3 billion

1990: $721.4 billion

2000: $1.37 trillion

2010: $2.6 trillion

2015: $3.21 trillion

*

U.S. health-care expenditures: per capita

(not adjusted for inflation)

1960: $146

1970: $355

1980: $1,108

1990: $2,843

2000: $4,857

2010: $8,404

2015: $9,990

*

U.S. health-care expenditures: percentage of GDP

1960: 5 percent

1970: 6.9 percent

1980: 8.9 percent

1990: 12.1 percent

2000: 13.3 percent

2010: 17.4 percent

2015: 17.8 percent

Source: U.S. Centers for Medicare and Medicaid Services

paul.sisson@sduniontribune.com

(619) 293-1850

Twitter: @paulsisson

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