Chronic Care
by John Goodman
John Goodman is the president of the National Center for Policy Analysis.
By some estimates, more than half of US health care spending is for patients with chronic conditions. As I have previously reported, this money is spent very wastefully. Care is often delivered in discrete, disjointed and disconnected ways. The most efficient form of therapy (drugs) is substantially underutilized. And many chronic patients are not receiving care at all. Care is often delivered in discrete, disjointed and disconnected ways. The most efficient form of therapy (drugs) is substantially underutilized. And many chronic patients are not receiving care at all.
Fundamentally, there are two ways to deal with chronic care. The current approach is a nonmarket approach, and it has the following 10 characteristics:
Completely suppressing the market for every facet of medical care and every type of health insurance — so that no one ever faces a real price for anything;
forcing health plans to take enrollees they don’t want at premiums well below the cost of their care;
forcing doctors to treat patients with complicated conditions for the same fees as easy-to-diagnose-and-treat patients;
paying doctors in a way that encourages uncoordinated and unintegrated care;
denying providers the opportunity to repackage and reprice their services in ways that would lower cost and raise quality;
