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Many Causes but Few Politically Sustainable Solutions

Steven A. Schroeder, MD

Arch Intern Med. 2011;171(8):722-727. doi:10.1001/archinternmed.2011.149

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

INTRODUCTION

At the start of his campaign for health care reform, President Barack Obama acknowledged a painful truth: to expand coverage without bankrupting the country would require bending the curve of health care expenditures. Unfortunately, while the 2010 Patient Protection and Affordable Care Act¹ makes substantial expansions of health insurance, it will probably do little to slow rising health care expenditures. As an early combatant in the battle to restrain excessive medical care spending—services that bring minimal or no health benefit—I was not surprised that the country is unprepared to heed the president's message, nor that political opportunists would use outrageous fear tactics, such as suggesting that giving people information on palliative care was tantamount to establishing death panels. To place cost containment efforts in historical context, I share my experiences and reflections, beginning early in my career at a time—1971—when the amount spent on medical care . . . [Full Text of this Article]

THE MANY FACETS OF RISING MEDICAL EXPENDITURES

Unexplained Variation in Use of Medical Services

Protechnology Payment Bias

Increased Use of Medical Technologies

Escalating Hospital Expenditures

Expansion of the Use and Numbers of Special Care Units and More Intensive Care at the End of Life

The Medical Workforce: Overreliance on Expensive Medical Specialists

Other Cost-Inflating Factors

CONCLUSION

AUTHOR INFORMATION

Author Affiliation: Department of Medicine, University of California, San Francisco.

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ABSTRACT | FULL TEXT