The United States is the only industrialized democracy that doesn’t provide health care for all its citizens. Of course, we’d like to cover all of the 50 million uninsured, but how would you pay for it? In fact, we could. The consensus view among health policy experts is that Americans pour enough money into health care — a $2.6 trillion industry — to have universal coverage.
"It’s generally agreed," says Dr. Elliott Fisher, of the Dartmouth Institute for Health Policy," that about 30 percent of what we spend on health care is unnecessary. If we eliminate the unneeded care, there are more than enough resources in our system to cover everybody." These are not the phantom savings on “waste and fraud” that the politicians always talk about. There are actual communities all over America that have found ways to cut costs while still providing excellent care. These places — from big cities to rural outposts — could be the model for achieving large savings in American medicine with no loss of quality.
These high-value communities are the subject of U.S. Health Care: The Good News, which traveled from coast to coast visiting doctors and hospitals that care about the fiscal health of their communities as well as the physical health of their patients. The documentary is based on the work of Dr. Fisher and his colleagues at Dartmouth, who publish the definitive study known as “The Dartmouth Atlas of Health Care.” Their work began in the 1970s, when doctors and economists began reviewing Medicare billing records by the millions. It sounds pretty boring, but in fact, they found something amazing: Massive variation from one town to the next in the treatment of the same ailment. This leads to massive variation in the cost of treating the same ailment. As a result, some U.S. counties spend $17,000 per year on the average Medicare patient, while others spend less than $7,000 per year with results that are just as good.
U.S. Health Care: The Good News looks at a few of these high-quality, low-cost regions of the country, to find out how they do it. They offer many different models of health care delivery, from small rural private practices to big-city clinics treating hundreds of thousands of patients. For all their differences, though, these communities have several important things in common, including a clear commitment by doctors and hospitals to lower the cost of health care.
Sadly, not every American community is as careful about costs as the places profiled in the film. Some counties run up health care costs more than twice the national average, with no better outcomes than the low-cost regions. The original plan for the documentary was to spotlight both low-cost and high-cost health care regions, but there was so much good news that the filmmakers never got around to the high-cost areas. They argue that those who pay medical bills — employers, insurance companies, Medicare, local governments and patients — should insist that every community provide high-quality health care as efficiently as the places featured in the film.
In addition to being a source of information, the aim of the film is to galvanize people to demand high-quality care at reasonable cost from their own local doctors and hospitals.