Is it Groundhog Day for health care spending?
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When we think about health policy, we’re reminded of the movie "Groundhog Day," in which Bill Murray’s character faces the same events, day after day, until he finally has a breakthrough, changes his life and moves forward.

We’ve been having a "Groundhog Day" experience when it comes to how we think about health care spending. For decades, we’ve been asking the same questions about health care spending: Who is to blame? Why do specific kinds of costs keep rising? Why does the United States spend more than other countries?

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Asking those questions repeatedly for a half-century hasn’t changed the trajectory of how much we spend or how we’re spending it. Instead of getting to the root of what’s driving health care spending, those questions have resulted in finger pointing: are spending trends the fault of hospitals, insurers, biopharmaceutical companies, others?

The blame game hurts us in two ways. First, it prevents us from finding workable solutions but assuming that someone else should be the one to change. And second, it risks dulling our ability to invest in truly breakthrough therapies out of a fear that care will be judged solely on cost.

But we’re making progress. We’re seeing serious efforts to thoughtfully assess the impact of transformative medicine, such as gene therapies to cure a specific type of blindness and certain cancers. And we’re seeing insurance companies, hospitals and physicians testing new payment mechanisms, engaging in outcomes-based contracting and trying other types of innovative practices.

Those kinds of specific endeavors are critical to breaking the cycle of blame and stasis. But we need to think broadly about our spending on health care, in aggregate. How well are we spending the $3.3 trillion we invest in health care – 18 percent of our GDP? 

We need to follow up by asking some tough, “third rail”-type of questions. For example, how much should we be spending, and upon what? Should health care resources be shared equally or geared toward the few who are most ill? Can we identify the specific places we can cut spending, so we can invest more in breakthroughs?

If we don’t ask those uncomfortable questions, then it will be difficult for us to get to the root of health care spending and develop some real solutions that put the focus back on why we have a health care system in the first place: for patients.

On Feb. 1—just before Groundhog Day—the National Pharmaceutical Council will kick off a research-first endeavor and national dialogue during a conference we are hosting with one of the leading health policy journals, Health Affairs. This will also serve as the kickoff for our Going Below the Surface campaign, which will live at goingbelowthesurface.org and on Twitter under the hashtag #GoingBelowTheSurface.

We have related research underway in the areas of how to address low-value care and willingness to pay for health care services among various stakeholders, and our intention is to use that research to engage stakeholders across the health care ecosystem in a constructive conversation about what’s driving health care spending in the United States and how we can spend more effectively.

This is conversation: we welcome “third rail” questions that we should consider as part of this ongoing research. It will take our collective ideas to move this dialogue forward and ensure its proper focus on helping patients.

We hope that you’ll join us in this important and constructive conversation and together, help us work through these challenging topics. Let’s not wake up tomorrow—on the real Groundhog Day—and find out that we’re repeating the same health care spending questions all over again.

Dan Leonard, MA, President, and Robert W. Dubois, MD, PhD, Chief Science Officer and Executive Vice President, National Pharmaceutical Council