Modification Vs. Reform
Today, there seem to be two primary conversations happening about health care. The first is political -- focused on increasing access independent of the economic issues of today's system. The second is financial - how we reduce costs and raise revenue to ensure the system's financial sustainability. Both make for interesting story lines. The young get more at the expense of the old. The poor get more at the expense of the rich. But they miss the point that reform must be about improving health outcomes at the same or lower total costs to the system over time.
We're all going to lose unless we shift our conversation from health care modification to wholesale change. We've been modifying for years, and it's gotten us a broken, economically bankrupt system. Yet many still cling to the idea that it can be further modified while others dig their heels in to protect what they perceive as a right.
Report after report details how the current system isn't sustainable and will fail our seniors and generations to come. The math tells the story. Our senior population in 1965 was 18 million, in 2009 is 39 million and in 2050 is projected at 89 million. Subsequently in 2008, 3.7 workers were contributing taxes for each beneficiary. By 2030, that figure is projected to fall to 2.4, and by 2080 to 2.1.
Even with strong economic growth, payroll taxes cannot sustain Medicare, so long as we are stuck in a pay for volume model. Furthermore, for the past seven years, Congress has delayed proposed cuts in physician payments. With the current law, physician payments are scheduled to be reduced by 21.5 percent in 2010. Realistically this can't happen given current physician business models. We need a different approach that sustains physician income, improves health outcomes and delivers more economic value.
It's time to challenge ourselves to imagine and create a new system. Let's start by asking what we want the system to do. Do we want it to provide universal coverage? Support our seniors in retirement? Drive innovation and preventive care? Let's agree on outcomes, and then design the right framework to enable a dynamic, patient-centric system that transforms the way care is delivered and allows individuals to manage their own health. We have a unique opportunity for change - let's take advantage of it.
August 11, 2009; 11:48 AM ET
Health Care Reform
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