The Institute of Medicine’s just-released “Best Care at Lower Cost” report can be taken optimistically or pessimistically, except that the glasses being presented aren’t half full or half empty. Instead you’ll find a ‘cost’ glass that’s one-third filled with wasted expenditures. Then there’s a one-third empty ‘quality’ glass to reflect the finding that one out of every three hospitalized patients are harmed during their stay. 

There’s more where that came from. On care coordination, the report found “229 other doctors involved in treating one average primary care physician’s Medicare patients,” and half of all adults (not just Medicare patients) reported “problems of care coordination, notification of test results, and communication among doctors.” On transparency, less than half of patients “receive clear information on the benefits and trade-offs of treatments” and nearly two-thirds of patients “don’t know how much their care costs until they receive a bill” – a finding that leaves the rest of us wondering how that other third figured it all out on their own.

It’s time to call off the fear mongering that says reform will ruin our current system, when in fact the system is doing a pretty ruinous job all by itself. The chair of the report’s 18-member author panel made up of doctors, business people and public officials was quick to point out that its findings give the lie to the “very common notion that quality will suffer if less money is spent.” What’s been portrayed as an “either/or” situation is really a “yes/and” choice. No one’s saying it will be easy to change a complex system, but that’s no excuse for not pursuing opportunities to take at least that one third off the top of our national health care spending tab – worth about $750 billion – and make a better system in the process.