Four Steps to Rein in Costs
Of course it is possible -- and absolutely critical -- to reign in health-care costs. The reason why policymakers are having such a difficult time is that they are focusing on the wrong problem. Starting with covering the uninsured is akin to building a house on quicksand. The uninsured crisis is a symptom of the larger structural problem of rising health-care costs. As in medicine, we need to cure the disease, not just alleviate its symptoms. To control costs and get to 100 percent coverage, we need to focus on four transformational changes in this order:
1. Individuals must become healthier.
Diabetes and obesity kill hundreds of thousands of Americans and cost our system hundreds of billions of dollars every year. But this is overwhelmingly a consequence of poor individual choices. Individuals must have incentives to make better decisions. Sen. John Ensign (R-Nev.) has a bill that would give insurers more latitude to provide incentives for good health.
2. Create a culture of health.
We can do this by redesigning how public and private institutions influence individual behavior. The food-stamp and Women, Infants and Children (WIC) programs should do more to provide incentives for the purchase of healthful foods. Employers should also be encouraged and rewarded for promoting health. Medicare and Medicaid should as well.
3. Dramatically improve delivery.
We should eliminate any financial incentive to do any test, treatment or therapy that does not directly benefit the patient or add value to the care process. Payments to doctors and hospitals must change from a transaction-based to an outcome-based model. And we need to migrate the system to proven best practices.
4. Radically change insurance financing.
Consumers should have the right to purchase health insurance from anywhere in the country, creating a truly competitive, national market. Health Savings Accounts should be available to everyone, regardless of how or whether they obtain insurance, and HSAs should be opened and funded for low-income individuals and families. We should provide incentives for the individual to root out waste by pursuing better care at lower cost.
Posted by: JMOB | July 27, 2009 12:40 AM
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