The Missing Pieces

President Obama zeroed in most of the right issues and made a number of common-sense suggestions on health-care transformation. However, there were some missing pieces to the picture that need to be filled in:

• We can track a FedEx package better than we can track a health record for two reasons: FedEx has created a single tracking system, whereas we have hundreds of electronic health record systems. We need the political will to force interoperability. FedEx tracking information flows freely. Privacy considerations inhibit, indeed sometimes excessively, the movement of health information. For example, lawyers have interpreted the Federal Education Records Protection Act to deny public health officials access to school health information. That should not be tolerated.

• We have an obesity crisis for reasons beyond the failure of individuals to exercise self-discipline. First, in poorer communities, residents have no access to healthy foods, places to exercise, or public transportation. We need to solve these problems to address their obesity issues. Second, food marketers have been successful at getting people of all classes addicted to excessive quantities of unhealthy food. We need to enlist food companies to make healthy foods and portions the easy choice.

• The President has correctly understood that government and private insurance systems that pay for activity rather than results cause excessive treatment that makes health insurance increasingly unaffordable. Payment reform is essential to reduce the rate of health care cost increases. However, we need to focus on the obstacles that prevent everyone from paying for results, rather than activities.

• Although evidence-based medicine sounds like it would significantly reduce costs, most of the variations between McAllen, Texas, and lower-spending communities relate to discretionary medical judgments in which higher-spending communities are simply more aggressive, but get no better results.

By Michael Critelli  |  June 15, 2009; 10:12 PM ET  | Category:  Health Care Reform , Primary Care , Public policy
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