SMRs and AMRs

Tuesday, December 26, 2006

Toward a new model of health care in the U.S.

by Leigh Pomeroy

Now that the '06 elections have taken the muzzle off the discussion of universal health care, it's time to move forward to a more effective and efficient health delivery system in the U.S. Rather than deal with all the rights and wrongs of the current system, which have more than amply been debated, I'm going to cut to the chase. Here is what needs to be done:
  • We must look to existing health care delivery models that work around the world. Which systems offer the best outcomes for the bucks? Where is longevity and quality of life highest for the amount of money spent?
  • We must look to existing delivery models for other services that work in the U.S. For example, the combination public-private model works very well in mail and package delivery. The fact that anyone can mail a letter to anyone in the U.S. for a single modest price and have it delivered within three days is something we take for granted, yet compared to most other systems it's phenomenal. This is a classic example of combining simplicity with efficiency. On the other hand, if someone wants a letter to arrive sooner, there are other public and private options. Another similar model is the public-private educational system in this country.
  • We must not limit the scope of observable models. For example, don't immediately exclude the British system because it's socialized. Do include the system of veterinary care in the U.S. It's far cheaper to take your cat in for a checkup and shots than it is to take your kid.
  • We must not let Congress rush to hasty political decisions. If anything, Congress should encourage states to experiment, let them see what works. Perhaps this means that Congress needs to set up a 10-year plan, for example, allowing so many years for experimentation, so many for formulation, so many for implementation.
  • We must use experts to oversee and come up with a final plan. This doesn't mean political appointees. This means hiring the best minds in the country to guide it in its transition to a more affordable, efficient and effective system.
  • We must include all players, from providers to insurers to institutions to patients to the people. Notice I left out the word "politicians" in this mix. Politicians must act more like judges than advocates. The only advocacy they should have is for an improved system.
  • We must realize that the employer-based health insurance system is a unique aberration in the U.S. and is virtually unheard of in the rest of the world. Put simply, it started during World War II when wages were frozen. In order to be competitive in the scarce pool of quality employees, corporations could only offer better benefits packages. As long as the economy was growing and health care costs were rising more or less equally with it, there was no problem. Now that health care costs are growing faster than the GDP and that the U.S. has shifted from a manufacturing economy to a service economy, the employer-based health insurance system has become outmoded.
  • We must look at the model of our democratic system in terms of doing what is best for the majority while guaranteeing the rights of the minority. Health savings accounts (HSAs), for example, succeed quite well for the former but can be devastating for the latter.
  • We must better integrate public health with health care. For example, spending hundreds of millions of dollars on improved cardiac treatment is a waste when society spends billions of dollars on promoting a lifestyle that is damaging to the cardiac system.
These are just an umbrella of suggestions. None of them are new, but because they are constantly being dismissed by special interests and forgotten by policy makers, they must continue to be reiterated.

Let us hope that our new Congress will be able to see the forest and not just the trees on the health care crisis. If they do, we might finally move forward toward change to a new model that is long overdue.

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1 Comments:

Blogger Patrick Dempsey said...

You left a huge hole in your analysis and you never commented on WHY health care costs have skyrocketed. Everyone bemoans the fact that health care costs keep rising, but no one gets to the core of the issue as to WHY these costs are skyrocketing. The answer is lawyers. Health care providers have been forced to raise their rates in order to cover the massive insurance they have to buy in order to fend off litigation from lawyers looking to get rich off of the one big case that'll make their career. As long as lawyers are allowed a free hand in suing providers whether or not they were negligent, costs will continue to rise regardless of the reform ideas you propose. As the threat of litigation is held over providers, this also will lead to fewer and fewer people entering the health care fields. Why would I go to med school for 15 years if one lawyer looking to make her mark can wipe me out with one lawsuit? Without seriously addressing the cost side of health care (i.e. medical tort reform) the costs will continue rise no matter how you reform the delivery (i.e. supply) side.

6:44 PM  

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