Peter Neupert
Health Technology Executive

Peter Neupert

Peter Neupert is Microsoft’s corporate vice president for the Health Solutions Group. He led Drugstore.com from 1998 to 2001.

Defusing the Health Care Bomb

When you defuse a bomb, you have to approach the problem carefully, thoughtfully and systematically so the bomb doesn't go off with injuries and unintended consequences.

In President Obama's remarks to the American Medical Association on Monday, the cost of health care being a threat to our economy (his words: a "ticking bomb") was rightfully raised -- and so were the many challenges of a system not designed to support consumer involvement, physician empowerment, preventive care and so on.

What's troubling is the approach to defusing this bomb. I fear that we may just be pulling at wires -- electronic health records, Medicare advantage plans, generic drugs and asking wealthy Medicare recipients to subsidize the system to make it economically viable. If we were to implement these proposals, would the root cause of the problem -- our health-care non-system -- be addressed?

I don't think so. Defusing this bomb requires an understanding of its engineering -- how we got into this mess. The "big red wire" that needs to be clipped first is the fee-for-service payment system driven by the government today through Medicare reimbursement decisions. Until that's addressed, the ticking bomb won't be stopped.

And it's certainly not about electronic health records. Feeding them to thousands of doctors through the stimulus package won't engender the change needed: improving patient health and paying doctors for new services that deliver better health outcomes at the same or lower cost. We can't attain the promised benefits of health IT without compensating physician innovation from volume to value. As much as health IT has the potential to help doctors with best practices and cut "waste", we need the right policy solutions to bring greater transparency to what patients purchase and the quality of those services...as illustrated through this story about colonoscopy pricing.

Raising taxes, cutting benefits or some combination will buy us more time--but won't address the core problems in the system nor improve its economic viability. Until we do that, we won't realize value--as measured by better health outcomes for every dollar we spend on health.

By Peter Neupert  |  June 16, 2009; 1:06 AM ET  | Category:  Electronic medical records , Health Care Reform , Presidential leadership Save & Share:  Send E-mail   Facebook   Twitter   Digg   Yahoo Buzz   Del.icio.us   StumbleUpon   Technorati  
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Mr. Neupert - What you propose will be very diffcult. A panel of health care CEO's recently wrote a report for the New America Foundation. In it they strongly supported changing fee for service, but they estimted it would take 10 YEARS just to get it out of Medicare.

My point is that there is enough money wasted by private insurance
companies in high overhead, physicians & patient compliance costs and in high drug prices for us to give Super Medicare for All (HR676) and it will not cost any more money than we are now spending. This will be very difficult to achieve, but I assure you it will be a piece of cake compared to what you propose. After we get everyone covered, then we can work on your hard problems, and the uninsured won't be dying while we do this

Look, in the past, US auto makers managed to divert outrage about the
patently unsafe cars they were building by concentrating interest on
drunk driving and speeding. Now, of course, these did contribute to
the problem, but now we know that there were other important factors
such as unsafe design and improper maintenance. The situation is
similar today. The powerful profit making health insurance industry is
fighting for its survival. They want to direct attention away from the
quick and easy and cheap fix that will give decent health care to
everyone, but eliminate their industry like the buggy whip. They want us to look at the other important, but very difficult problems which won't hurt them at all. And, unwittingly, you are helping them.

Posted by: lensch | June 19, 2009 5:05 PM
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I concur with the thoughtful comments of Peter Neupert. Healthcare reform is one of the most contentious public policy issues we as a country have encountered in quite some time. Legislation alone won't do the trick, as legislation is usually more of a blunt instrument rather than a scalpel. For Americans to realize affordable universal healthcare, and better healthcare service, it will take a commitment of many different people. I'm talking not of Democrats and Republicans, or even liberals and conservatives. It's much more than that. Various interest groups, from physicians to insurers to corporations, unions, technology vendors and researchers will need to band together to address this problem, and check their egos - and political dogma - at the door.

Peter Neupert is correct in asserting that we need to approach the problem of healthcare reform intelligently rather than with too much passion and no common sense. If we don't correctly look at how the various proposed solutions might play out by carefully modeling the various scenarios, we'll never anticipate the terrible unintended consequences of any proposed piece of legislation.

The recent findings of the Congressional Budget Office show the flaws in the ready-fire-aim approach of the different legislative proposals offered up by Congress to date. And while the White House is anxious to seize the moment to get legislation passed, is it too much to ask that we take the time needed to get this right? Instead of the various sides going to the mattresses, it's critical that the various interest groups put aside their egos and take a hard look not only at what they might be able to compromise, but also, as Mr. Neupert so adroitly suggests, at the key root causes that drive the problem.

Amid the rising noise of rancor in Washington, Mr. Neupert's modest proposal may be one of the few quiet voices of reason I've heard. To borrow a phrase from the TV show LOST, we can live together or die alone. I pray that common sense, not the loudest alpha male voice in the room, is what wins the day. Perhaps if we shouted less and listened more, we might all benefit.

Posted by: groupeone | June 19, 2009 12:36 PM
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