Robert F. Graboyes

Robert F. Graboyes

Robert F. Graboyes is the senior health care adviser at the National Federation of Independent Business (NFIB) in Washington, D.C.

Innovation, Timeliness, Choice, Quality

Ask a small business owner what works in the health-care system, and his answer is likely to be "not too much." But American health care has some truly admirable features, and we don't want to jeopardize them as we pursue reform.

A glance at the Nobel Prize roster shows how American research and development drives global medical innovation. Lots of those innovators are small businesses or started out that way.

Americans don't endure queues that bog down other systems. (Sylvia de Vries fled Canadian red tape for American care -- not the reverse -- to have her 34-pound cancerous tumor removed.) Americans can choose physicians, hospitals and other providers. We're among the healthiest people on earth and our shortcomings stem more from behavior, environment and heredity than inadequate health care. (The World Health Organization's oft-cited "U.S. ranks #37" is a hollow number, arbitrarily jumbling health care and non-health care data.)

Make no mistake -- America needs health reform. Small businesses don't have the health-care choices available to most Americans, and the fault lies largely with malfunctioning markets. We must be careful, however, that reforms don't jeopardize our system's virtues. Holes in coverage and lapses in quality are both driven by costs that are high, rising, unpredictable and detached from underlying economics.

Laissez-faire will never be an option in health care, but reforms must unleash markets to reduce wasteful spending and drive costs down. Decision-making must arise primarily from patient-provider collaboration, not distant experts in government. There must be competition among providers and insurers, who need sufficiently flexible pricing, treatment, and reimbursement in order to experiment and innovate. Governments cannot simply order innovation to occur. Transparent cost and outcomes data, supported by improved health information technology, must inform decision-making between patients and doctors. Broader health insurance coverage can make the system more efficient and reduce political pressure for centralized solutions.

By Robert F. Graboyes  |  July 2, 2009; 11:26 AM ET  | Category:  Health Care Reform Save & Share:  Send E-mail   Facebook   Twitter   Digg   Yahoo Buzz   StumbleUpon   Technorati  
Previous: Letting Patients Share in Treatment Decisions | Next: Across the Country, Some Systems Are Getting It Right


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Clearly the people who comment do not do any investigation before they comment. I believe Mr. Graboyes has the facts right.
About 250 million Americans get great health care, approx 46 million are not getting the same level, or non ideal health care. Many of them are illegal aliens that do not pay taxes or have any documentation of there status. They do use our ER's and hospital for health care although not ideal our ER"s/ hospitals are delivering high quality care. They also get care inexpensive pay clinics for routine care that cost about $50 a visit on average. Many working poor and illegal aliens use this for their health care. Do you see people dying in the streets of America from lack of health care or from violent crimes? I think the latter. In order to get this situation under control all aliens and citizens must participate, thus the illegal part of the 46 million have to be documented and participate i.e. file a tax return. This will also reduce the "cash" economy that evades taxes and will help pay for some of their care. I just wish the people who wrote the comments above would try to not be so bitter by saying the health care system needs to be dismantled. We enjoy the best health care system in the world. Can we be better? of course that,s part of being an American , by nature we want to be the best. The comments about WHO and America being ranked low as compared to those other great countries like Canada and Europe(I do not see many Americans migrating to these great places) are ridiculous. For example infant mortality stats are totally wrong the commentator has to look the definition of infant mortality in each country. If they did this they would find that the definition of what is an "infant mortality" is differs from country to country, thus each country has there own rules. These stat's are like comparing " Apples to Oranges ". It's ok to give an opinion but do not quote "facts" that you may have read in the Lay press as they are often sensational factoids to sell advertising space on TV or newspapers .
Lets understand an undisputable fact proved by numerous studies by the left and the right,we have the best health care system in the world !!! lets be realistic and try to build into a more cost efficient and better system.

Posted by: drevansch | July 14, 2009 11:47 PM
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It is my guess that millions of Americans would gladly queue for health care if they had the opportunity to receive health care at all.

Posted by: kathy-ellen | July 6, 2009 7:39 PM
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Part II

Actually the waits are nowhere near what the conservatives say. For Canada go to

Furthermore the reason the wait time are longer for these benefits has nothing to do with the fact that other countries have more efficient systems, but because they spend less than half per patient than we do. I invite the reader to try to imagine the wait times in our system if we cut health care payments by over 50%.

Finally, the bottom line is that if you look at all the basic public health statistics (life expectancy, infant mortality, etc.) or the WHO rankings, these other countries provide much better health care and they do it at much less cost.

"We're among the healthiest people on earth..."

There are 16 basic bottom line public health statistics, not only life expectancy, but also life expectancy after 60, not only infant mortality, but also birth weight, etc. The US ranks near or at the bottom in each one among industrialized countries in spite of the fact we spend more than twice as much per person on health care.

Mr Graboyes tries to slough these embarrassing facts off on "behavior, environment and heredity" but the fact is that the Australians are as obese as we are, they smoke as much and drink more, yet they too beat us out in health care results.

As for the other two factors, it is well to note that in the 50's we lead the world in life expectancy and did well in the other public health statistics. But from then on, we turned health care over to profit making firms who put profit above all, while other countries instituted government run programs whose goal was good efficient health care. Since then, they have pulled in front of us.

And so on.

Posted by: lensch | July 3, 2009 11:05 PM
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Part I

I would have to write a much longer comment than the above article to correct all the errors and misrepresentations in it. I'll just do a few.

"Sylvia de Vries fled Canadian red tape for American care -- not the reverse -- to have her 34-pound cancerous tumor removed."

This is a typical attempt to prove a general fact by a single example. Actually, 150,000 Canadians (0.6% of their population) come to the US each year for medical treatment. Half of them are sent here and paid for by the Canadian health care system
for rare treatments that we have more experience in since we are 13 times larger. The remaining 0.3% are probably rich people who want fancy food in the hospital.

In poll after poll, the Canadians have preferred their system to ours by over 90%. The last in 8/2008, had 91% of them preferring their system

"Americans don't endure queues that bog down other systems."

Mr. Graboyes says wait times in other countries are longer than those in the US, but that only looks at the patients who actually received the surgery. Since everyone is covered in the other countries, that does not effect the result, but in the US where millions have no insurance, there are many people who need surgery who never get it. His statistics ignores these people whose wait time is infinite. Obviously if you only give a benefit to some of the people you can do it faster.

Posted by: lensch | July 3, 2009 11:03 PM
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