Saturday, October 10, 2009

The Roadmap to Reform

I have a number of very intelligent friends and colleagues, each of whom are better writers than I am. Sadly (mainly for my readers) I am the one who has the foolishness to expose my talents to the public.

Here is another take on insurance reform, provided not by my friend Bart, but by a different colleague, which also makes perfect sense. I am publishing this even though my friend believes in the "private/public consortium" which I do not, the rest of this vision is clear and essentially uncontestable. In the interest of balanced reporting, I present his plan in its entirety.

Without further ado....

Medicine is sick.

I have talked to hundreds of doctors, scores of hospitals, and many outpatient ambulatory medical center and hospital administrators. They all agree. Medicine is sick. They all agree, something must be done about the way medicine is practiced in America. They all agree that the state of our healthcare PAYMENT system is flawed. I have never encountered anyone who is intimately associated with any aspect of healthcare payment and/or delivery in this country who will say "I like things just they way they are. We have a perfect system." There seems to be universal agreement that healthcare reform is necessary. There seems to be universal agreement that the status quo is unacceptable. WHY THEN ARE WE GRIDLOCKED? Why are Americans so upset with our lawmakers? Why is there a schism between liberals and conservatives? Why is there no agreement between doctors and lawyers? Do doctors serve patients, or themselves? Are doctors capitalists, or socialists? What is the future of healthcare?

I have my own version of reality to present to you. I can think of only one other conflict that seems anywhere close to as epic and complex as this, the Israeli / Palestinian conflict. Just as there is an agreed upon Roadmap to Peace, I have devised a roadmap to health care reform. I would like to present it for your consideration.

The Roadmap is linear. Each step builds upon the one before it. One can not bypass the order with success. I will also suggest that our current failure in reform is because conservatives want to begin with step number 1, and Liberals would like to begin with step number 10. Conservatives do not want to see step 10 come to fruition, liberals see steps 1-4 as benefiting corporations and not patients. Meeting, and beginning, in the middle will not work. Compromise will fail. We must all see the road map, with its relative merits, inevitability, and progress sequentially, together.

I will attempt to elaborate on each point in series. But the roadmap is as follows:
  1. High deductible, low cost, catastrophic coverage insurance available on the open free market (not government provided, but perhaps government supported).
  2. Removal of exclusionary criteria from normal insurance qualifications such as pre-existing conditions and lifetime benefit maximums.
  3. Price transparency in the medical charge structure. The price of services should be based upon the demonstrated resource based relative value scale, and the price is consistent and transparent, regardless of payer.
  4. Open market for insurance across state lines, and across employers. Open markets are effective markets. Limited, restricted, or bottlenecked markets lead to price inflation.
  5. Insurance portability. Your purchased free market insurance stays with you, not your employer. Employers may offer attractive insurance incentives and health care savings account allotments in order to attract and retain employees, but your insurance belongs to you, not your employer. Employers should not be obligated to provide insurance any more than they should be obligated to provide you with transportation or groceries.
  6. Tort reform will limit the practice of defensive medicine and curb the lotto mentality held by many patients, and many lawyers.
  7. Utilization oversight. Doctors would, and should be compared with national benchmarks as to appropriate utilization and outcomes, and outliers should be examined. This may or may not be done using the payment structure.
  8. Wellness reforms. With responsible insurance companies, payors, and responsible doctors, the patient will be asked to take increasing responsibility for themselves. Healthy lifestyles can be subsidized via discounts and unhealthy lifestyles will be taxed via higher premiums.
  9. End of life care. Responsible consultation and oversight is necessary in this area, but only after the patient has become engaged in his/her plight.
  10. Universal coverage options which include both a two tiered public/private consortium, and establishment of a minimum humane level of care agreed upon by committee, paid for by all, and availabe to anyone.

I look forward to its elaboration. I am just barely idealistic, and nieve enough to think this is actually possible. I believe that heathcare DELIVERY in America is some of the best in the world. However, its PAYMENT system is among the most shameful. Our current growth rate is unsustainable. The bubble will burst….eventually.


Anonymous said...

This is quite a refreshing middle ground debate that in large part, I fully agree with. We are such a reactive healthcare provider versus proactive (ie preventative medicine) provider - its no wonder this (healthcare costs, frustrations, inefficiency) continues to worsen each year. Whether you agree with Obama or not, those of us in healthcare have to agree that at the end of the day, this reform is just what the doctor ordered.

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