Healthcare Christmas List: Top 5 Wishes

If I could get Santa to grant me my wishes for meaningful healthcare reform, I would be opening the following gifts:

1. Payment and Insurance Reform:  Combine Pay for Performance with Reforming Insurance to provide access for all.  We have to stop rationing healthcare based on wealth, but at the same time have to change reimbursement so it is for results, not procedures.
2. Health Courts: Replace malpractice system with health courts, comparable to bankruptcy courts.  Have judges advised by medical experts and eliminate all the wasteful, unnecessary lawsuits and lawyers.  Docs need to have this eliminated to put an end to defensive medicine.
3. Evidence-Based Medicine: The level of variation in medical practices across the country makes medicine seem more like art than science.  In order to reduce demand for services, we must hold physicians accountable for using the best proven practices for treatment.
4. Best Practices/Metrics: This present involves eliminating all the waste in the healthcare system associated with serial, inefficient, and ineffective processes.  Requiring all hospitals to integrate best practices along with measuring their performance, tying performance to metrics with reimbursement will be true game changers.
5. Wellness Initiatives: We have an epidemic of obesity that is placing an enormous burden on the system.  Making a radical impact on improving our nation’s health will be the single biggest lever to reduce the burden that 60 Million obese Americans place on the healthcare system.

That’s all I want for Christmas, Santa.  Is it too late to wrap these gifts and include them in the Healthcare Reform bill so that we see a reduction in healthcare costs in the next 10 years?  If not, the nation will look like Massachusetts.  Insurance for all but no primary care doctors to see them, resulting in zero benefit in terms of access and quality.  Just more dollars for the same ineffective healthcare system.

Please Santa.  No more ties.  Just these 5 gifts.

Access, Access Everywhere

The Obama Administration’s Healthcare plan touts 3 Goals:  Improve Access, Increase Quality, and Reduce Cost.  No doubt these are the right goals.  As far as I can see, the 95% focus today is on the first one only.  Every legislative discussion is about Providing and Requiring Insurance Coverage for all Americans.  No doubt that this is a great social initiative for an industrialized country.  The fact that we have so many uninsured citizens is an embarrassment.  Don’t forget, though, that many of the uninsured are also illegal residents of the US, but the remaining numbers of uninsured is still too high.

I was on a plane with Chris Matthews of MSNBC last week and when I mentioned my firm was heavily involved in Healthcare, his immediate comments were that he was hearing the coming legislation would require everyone to have insurance coverage and the administration was pushing the equivalent of an NGO:  Non-Government Organization that is not directly a part of a government organization and has private & public financing.  This NGO would provide a health insurance alternative to make insurance coverage affordable for all Americans and potentially provide price pressures on existing private insurance plans.  Notice how the immediate reaction to healthcare changes in the US are all around access, access, and more access.

Sounds noble but how does this support quality and cost?  As Michael Gerson notes in the Washington Post today, “the administration, it turns out, has no serious plan to control healthcare costs.”  Fundamentally, providing government benefits are expensive and require funding.  So some form of taxes will be required to provide this benefit.  After having taxpayers fund this healthcare insurance option, then what do we have?  More people getting more doctor visits, more tests, more hospitalization, and more pharmaceuticals.  No wonder big pharma is behind this – this will increase demand for their products from paying customers.

Don’t get me wrong.  I am not in favor of the Republican plan to make people better consumers of healthcare, somehow thinking that people with no medical understanding will shop for healthcare the way they shop for televisions and clothes.  Utter nonsense.  And, by the way, if they had the ability to make cost-based choices, the assumption that individuals would choose the cheapest alternative is also flawed logic.  When your health is involved, do you want the best or cheapest?

So I have a comprehensive plan to transform healthcare, which I will lay out over the coming weeks.  I believe the administration is not reaching far enough in its effort to transform healthcare.  If we are not bold, then we will be left with no other alternative but to ration healthcare for the elderly and chronically ill.  We already ration healthcare today:  its the poor and underinsured that are impacted the most.  So the administration, unwittingly, proposes to shift that rationing to the old and very sick.  I don’t like it one bit. 

Do you agree that this single-minded focus on access is flawed?  Do you want to really transform healthcare, not just play the shell game?