Transcript
DAVID CUTLER: So, if you go back to my glory years in the Clinton Administration, the goal is to save money and cover more people. Which, if you're going to save money and uninsured people are going to get more care, inherently means that those people who have insurance, typically people in this room amongst them, will wind up getting less care. And that sort of conflicts with the idea about peoples quality should improve and people should have access to high-quality medical care. So it's sort of no wonder that plans like that typically fail.
There are other kinds of plans out there. So, there's been a lot of emphasis placed on improving quality. There are things like information technology investment and other kinds of measures. The IOM had a big report on this, which then runs into the problem of, gee, that's great, but how can we afford it?
One way or another the issue of costs versus, you know, how much we spend versus what we're getting is sort of central to essentially every debate about health care reform. You need look no further than the current flap we're having over the Medicare Drug Bill and would we have done it if the thing cost more or would we not have done it. And, you know, how do we both save money in the program and also give more benefits when, typically, most of the things we know how to do are to spend money to get stuff or not spend money, not to get stuff.
So the central questions, as I see them, are first: What do we get for increased medical spending? That is, how do we decide, as a whole, whether it's worth it or not. I'll give you sort of what I thin is conventional wisdom, although I've been out of Washington sufficiently long that I'm not sure I know conventional wisdom anymore. But I would say that the conventional wisdom is that we don't get very much for what we spend.
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