Saying policymakers must get a grip on the crisis now, David Walker asserted they need to tackle three politically dicey problems to regain control over runaway federal spending on health and welfare programs: Reform Social Security, Medicaid and Medicare; bring more restraint to other federal spending; and revise tax policy.
"The federal government is on an imprudent and unsustainable fiscal path. It has serious problems. . . . We ought to take a modern Hippocratic oath [to] do no harm. Don't dig the hole deeper. How can we use what we have more wisely? Because the answer is not spending more money."
Walker was the first to testify at an all-day hearing before the Citizens' Health Care Working Group, a committee created by Congress to study health care coverage, costs and access. Friday's hearing, held at the state Capitol, was the second of several regional hearings across the country.
The 14-member group, assembled in February, will issue a health report to the public when it completes its two-year study. Its recommendations are expected to result in federal legislation.
Walker said policymakers can start by answering fundamental questions:
l What are the basic and essential services every American should get?
l What is the appropriate balance of responsibility - between government, employers and individuals - in financing health care?
l What types of incentives are needed for medical providers to make prudent decisions to reduce costs.
To the last question, Utahns Scott Williams and Stanley Huff highlighted the potential cost-savings and practical efficiencies of managing clinical and financial records electronically.
Williams is the project director of the Utah Health Information Network, an electronic network that links health care providers to financial and clinical information. Huff is a professor of medical informatics at the University of Utah and a senior medical informaticist at Intermountain Health Care.
While information technology requires a steep initial investment, it can reduce long-term costs associated with managing paperwork, processing claims and allocating staff time.
IHC's system logs every patient-doctor interaction into a database that can be consulted from any site. For example, a patient's allergic reaction to a certain medication would be noted in the system, and that information would be available to any doctor, nurse or pharmacist who later treats the patient.
Information systems also can store reams of information on drug interactions, costs for various treatment options and best practices for treating a multitude of conditions.
"Information technology, properly applied, can increase the quality of health care and decrease the cost of health care at the same time," Huff said. "We should continue to invest in research and development of health care information systems."
U.S. Sen. Orrin Hatch urged members of the working group to find "free-market, free-enterprise, decent, political ways" to improve the country's health care system.
He advised the group to keep political realities in mind - Democrats' desire for a broad, if not universal system and Republicans' concern for the bottom line - without letting politics dictate recommendations.
