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.
June 16, 2009; 1:06 AM ET
Electronic medical records
Health Care Reform
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Posted by: lensch | June 19, 2009 5:05 PM
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