RSS Feed
One Small Step/One Giant Leap
Where were you when you watched Neil Armstrong's "One small step for Man" 40 years ago today? (My apologies if you weren't alive yet). I was a lad of 11 attending Camp Hidden Hollow in the verdant, rolling hills of central Ohio. The staff assembled all of the couple hundred or so campers outdoors, on benches arranged in concentric circles under a starry sky, to watch history in the making on a grainy black-and-white TV. The U.S. didn't get to the moon overnight, though. It took over a decade of concerted effort, successive approximation and un-wavering dedication to achieve that goal. It wasn't until years later that the general public was made aware of just how tiny that first moon-landing's margin for error was. Neil and Buzz put down at Tranquility Base with only 20 seconds of fuel left in their lunar landing module.
Considering the present state of the economy, it seems as though we have similar slim margins for error when it comes to re-shaping the nation's health-care into a system. Now is not the time to hustle half-baked legislation through congress. And truth be told, there is really no need for one massive, all-encompassing bill to re-make health-care. There are a small number of key leverage points that we can adjust independently to produce the desired end-state of cost-effective, high-quality health-care for all.
The president, unwavering in his determination to sign health-care reform legislation into law this session, is pushing his Democrat-controlled Congress hard to produce a massive, comprehensive health-care reform bill now. Unfortunately, there seem to be many unanswered questions, raised by folks not known for their radical views, like the Congressional Budget Office and moderate congressional Democrats, especially whether we are addressing the correct drivers of the high cost of health-care. The worst thing we can possibly do is pay more for the same health-care outcomes we are currently receiving.
It is possible to rein in costs. Here are the main "value-based" levers to fix health-care, as I see them:
1. It's time to move away from toxic piecework payment incentives for primary-care services, embracing instead accountable, patient-centered primary care.
2. There may be no need for a public insurance option if instead we regulate insurers' profit margins in much the same way as we regulate utilities' margins.
3. If we want more primary care practitioners, lets open the spigots (i.e. training funds) for the primary care residencies. Conversely, lets clamp down on funding those specialties already in over-supply.
4. Let's encourage more creative uses of financial incentives to keep well folks healthy and to move those with a chronic condition -- diabetes, for example -- to a state of greater adherence with best clinical practice (sort of like a safe driver incentive).
5. It's time for both individual and corporate insurance mandates. We're all in this thing together, after all.
If we focus on these few, small steps, I believe that we can truly achieve the giant leaps in health-care transformation we need to remain competitive in the global economy. Like the Apollo program, it's worth taking our time to get it done right the first time around.
By
Raymond J. Zastrow
|
July 20, 2009; 12:01 PM ET
| Category:
Health Care Reform
,
Health costs
Share This: 
Technorati
| Del.icio.us | Digg | Facebook
Previous: The Heavy Lifting of Health Reform |
Next: Waiting for the Roof to Leak
Posted by: lensch | July 22, 2009 3:16 PM
Report Offensive Comment
The comments to this entry are closed.
"There may be no need for a public insurance option if instead we regulate insurers' profit margins in much the same way as we regulate utilities' margins."
Profits are a very small part of the waste private insurers inflict on the system. Because the sole goal of a corporation is to maximize return to stockholders, insurers take many actions that are inimical to good effective health care.
They call the percentage of the premiums they pay out in medical benefits, their "Medical Loss Ratio" (MLR). They use the word "loss" because they regard payments to patients as a loss. They believe that the lower the MLR, the higher their stock price. So they do everything they can to avoid paying patients and to increase the part of their budget that does not go to benefits, i.e. the overhead. This leads to about $400 Billion of waste each year as compared to health insurance systems that do not have private insurers.
We will never get an efficient quality system until we get rid of private insurance with its perverse incentives.