Health Care Reform: Treatment Effectiveness Information Nationwide

University of Arkansas at Little Rock Law Review Volume 36 | Issue 4 Article 3 2014 Health Care Reform: Treatment Effectiveness Information Nationwide Robert B. Leflar Follow this and additional works at: http://lawrepository.ualr.edu/lawreview Part of the Health Law and Policy Commons Recommended Citation Robert B. Leflar, Health Care Reform: Treatment Effectiveness Information Nationwide, 36 U. Ark. Little Rock L. Rev. 606 (2014). Available at: http://lawrepository.ualr.edu/lawreview/vol36/iss4/3 This Article is brought to you for free and open access by Bowen Law Repository: Scholarship & Archives. It has been accepted for inclusion in University of Arkansas at Little Rock Law Review by an authorized administrator of Bowen Law Repository: Scholarship & Archives. For more information, please contact . HEALTH CARE REFORM: TREATMENT EFFECTIVENESS INFORMATION NATIONWIDE Robert B Leflar Most of the debate over the Patient Protection and Affordable Care Act (PPACA) and its implementation has centered on access issues: expansion of access to care among the uninsured and underinsured through insurance reforms. True enough, increasing access to care is the law’s chief goal. But the law’s architects and the new programs’ builders aspired to broader objectives. They also sought to advance health care quality and to restrain health care inflation by helping rationalize the practice of medicine. This paper focuses on the law’s attempts, largely ignored in the national debate, to reduce the amount of non-productive, expensive waste in American health care practices, enabling us to deploy our limited resources on what actually improves people’s health. It is clear from comparative international statistics (see Figures 1 and 2) that virtually every other advanced nation operates its health care system with greater efficiency than we operate ours. Further, health care costs have been rising in the United States far more quickly than inflation generally, so that an average family of four paid $5,800 for health insurance in 1999, but just fourteen years later paid more than $16,000 (Figure 3)—an inflation rate far outstripping health cost increases in other countries. (Thankfully, the rate of increase of health care inflation seems to be abating recently.)1 International price comparisons for particular procedures and drugs bring home the radical cost differences to patients needing those procedures or drugs: Americans pay far more than patients in other advanced nations.2 * Ben J. Altheimer Professor of Legal Advocacy, University of Arkansas School of Law, Fayetteville, Ark.; Professor, University of Arkansas for Medical Sciences, Little Rock; . I thank the UALR Law Review editors for organizing the February 2014 symposium on the Affordable Care Act at which I gave the presentation on which this article is based, Lauren Summerhill for dedicated research assistance, and Frank Griffin, Doug Kamerow, and Mick Tilford for their useful suggestions. 1. See, e.g., David Blumenthal et al., Health Care Spending─A Giant Slain or Sleeping?, 369 NEW ENG. J. MED. 2551, 2551 (2013) (observing slower growth in health care costs in 2012 but concluding continued cost control efforts are needed). 2. See, e.g., Elisabeth Rosenthal, The $2.7 Trillion Medical Bill: Colonoscopies Explain Why U.S. Leads the World in Health Expenditures, N.Y. TIMES, June 2, 2013, at A1, available at http://www.nytimes.com/2013/06/02/health/colonoscopies-explain-why-us-leads -the-world-in-health-expenditures.html?pagewanted=all&_r=0. 606 2014] HEALTH CARE REFORM 607 Fig. 1. Percentage of Gross Domestic Product Spent on Health Care, 2012.3 Fig. 2. Health Care Expenditures per Person-Year, 2011.4 3. Quick Reports, Global Health Expenditure Database, WORLD HEALTH ORG., http://apps.who.int/nha/database/Key_Indicators/Index/en (last visited Sept. 18, 2014); Countries: Sri Lanka, WORLD HEALTH ORG., http://www.who.int/countries/lka/en/ (last visited November 12, 2014). 4. OECD Indicators, HEALTH AT A GLANCE 2013, ORG. FOR ECON. COOPERATION & DEV., at 155 (2013), http://www.oecd.org/els/health-systems/Health-at-a-Glance-2013.pdf. 608 UALR LAW REVIEW [Vol. 36 Fig. 3. Average Annual Premiums for Single and Family Coverage, 1999−2013.5 What do we get for what we spend? In comparison with other countries, the picture in public health terms looks mostly, but not entirely, bleak.6 The figures below depict several dimensions on which health outcomes can be compared. These are measures to which the quality of the health care systems contributes some, but not all, of the differences among nations.7 Perhaps the most disturbing is Figure 9, depicting the relative improvement among leading nations over a 20-year period in life expectancy at birth. The United States rests at the bottom. 5. Average Annual Premiums for Single and Family Coverage, 1999−2013, HENRY J. KAISER FAM. FOUND., http://kaiserfamilyfoundation.files.wordpress.com/2013/08/2013-ehbs1-11.png (last visited Sept. 18, 2014). 6. See, e.g., Karen Davis et al., Mirror, Mirror on the Wall: How the Performance of the U.S. Health Care System Compares Internationally, COMMONWEALTH FUND, at 7 (2014), http://www.commonwealthfund.org/publications/fund-reports/2014/jun/mirror-mirror (ranking the U.S. “last or near last” among eleven advanced nations on dimensions of health care performance such as health outcomes, access, efficiency, and equity). 7. For some measures, such as infant mortality and life expectancy at birth, a country’s educational level, dietary practices, extent of income inequality, and other environmental factors contribute as well. 2014] HEALTH CARE REFORM 609 Fig. 4. Infant Mortality Rates, Internationally and by State.8 Fig. 5. Hospital Admission Rates for Diabetes Complications.9 8. T.J. Mathews & Marian F. MacDorman, Infant Mortality Statistics from the 2009 Period Linked Birth/Infant Death Data Set, NAT’L VITAL STAT. REP., at 1, 17 (Jan. 24, 2013), available at http://www.cdc.gov/nchs/data/nvsr/nvsr61/nvsr61_08.pdf (state comparisons); The World Factbook, CENT. INTELLIGENCE AGENCY (2012), available at https://www.cia.gov/ library/publications/the-world-factbook/rankorder/2091rank.html (international comparisons). In addition to the quality of health care systems, other factors such as nutrition, education, and relative income inequality contribute to these statistics. 9. OECD Indicators, supra note 2, at 109. 610 UALR LAW REVIEW [Vol. 36 Fig. 6. In-Hospital Mortality for Acute Myocardial Infarction (Heart Attacks).10 Fig. 7. Breast Cancer 5-year Relative Survival Rates.11 10. OECD Indicators, HEALTH AT A GLANCE 2011, ORG. FOR ECON. COOPERATION & DEV., at 109 (2011), http://www.oecd.org/els/health-systems/49105858.pdf (Fig. 5.3.1). 11. Id. at 121 (Figure 5.9.2). 2014] HEALTH CARE REFORM 611 Fig. 8. Life Expectancy at Birth, 2011.12 Fig. 9. Increase in Life Expectancy at Birth, 1988-2008.13 The conclusion that must be drawn fro (...truncated)