Taming the Beast of Health Care Costs: Realigning the Interest of Individuals and Populations

The Patient Protection and Affordable Care Act (hereinafter the “ACA”) has, as its primary goal, universal access to health insurance for all American citizens and legal residents. When fully implemented, the ACA will provide insurance to an additional 32 million uninsured Americans. While this is certainly a laudable public health goal, the additional lives that will be added to the insurance rolls as well as new minimum coverage requirements will create fiscal burdens for an already overblown health care system and costs may quickly reach a crucial tipping point. The ACA does create some incentives to reduce costs but providers are understandably motivated both by their professional responsibilities and maximizing gain from payers. How to create incentives for providers, payers and patients to consider the welfare of the medical commons in making treatment decisions will require difficult adjustments to shift the culture of health care from one of mindless overutilization to one of mindful and appropriate utilization. Without such a cultural change, the prophecy of Garrett Hardin, Howard Hiatt and a myriad of health economists is inevitable: “Ruin is the destination toward which all men rush, each pursuing his own best interest in a society that believes in the freedom of the commons.” Our legacy must be a health care system that not only provides high quality, safe health care for all of its current users but will also be economically sustainable for future generations.