Health Care Reform – the Next Round
Is health care reform dead? Doubtful? What will it look like? Not nearly enough.
So I want to get a head start on the next round.
Moving ahead
Because whatever happens in this round, round 2 cannot come soon enough. It is unrealistic to expect health care reform to be a once and done proposition. The Model T was not invented with 4 wheel anti-lock disk brakes or fuel injection.
So over the next few weeks, I would like to take a look at some of the issues that will still remain even after health care reform legislation is passed.
But first let’s give some thought to what we want from our health care system.
Universal access.
This has to be at the top of the list. Universal access is important for several reasons. To listen to the current debate, one might think that universal access is only about spreading the risk between the healthy and the sick. If we can find a way to get more healthy people into the system it will spread the cost and make health insurance less risky for insurers.
Universal access is central to cost control.
According to a Commonwealth Fund study, the United States ranks 19th among industrialized countries in deaths preventable by health care. And as the number of uninsured increase our ranking slides. Assuring all Americans that they can easily access health care is about a culture change. Those on the margins of our health care system generally don’t have access to good primary care.
They delay treatment until their condition requires more acute intervention, and then they are more likely to go to an emergency room, the most expensive care setting.
Universal care is also about quality care.
There are those who argue that we need to focus on the delivery of care first. Delivering quality care would lower the cost of health care, making it more affordable and consequently allowing more people into the system. I maintain, that the most significant impediment to a high performance health care delivery system is a fractured and fragmented patient delivery system.
Affordable care
Care is not accessible if it’s not affordable. We must rethink what affordable means. Let’s not focus on isolated groups with affordability issues.
How much can we as a society afford? Is it 15% of our income or 5% of our income?
What is radical about this idea is that the financial exposure and risk is different. Just as universal access permits the healthy to subsidize the cost of health care for the sick; so a revised understanding of affordable care will enable those with high incomes to support the health care costs of those with low incomes.
We do this in many ways now, and in later posts I will explore how we do that overtly and covertly.
Quality care.
Americans expect the highest quality of health care. But do we get it? What is quality health care? What outcomes should we expect when we spend 16% of our economy on health care? What does it even mean to spend 16% of our Gross Domestic Product on health care? Is there such a thing as too much health care?
This will be the focus of my next post.
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