Healthcare Reform Model That Works

 Healthcare Reform Model That Works

It’s clear that the administration is now focused on improving Access to healthcare, with this being the headliner in all discussions about reforming healthcare. Next, the discussion moves to how to pay for covering these 47 Million Americans without coverage. Taxing the rich, popular, but an unabashed move to have government redistribute wealth. Also, discussions around changing the mechanism for setting Medicare reimbursement levels are discussed. But essentially, that’s it for specifics. Everything else around making a meaningful change to the cost curve is vague. Vague won’t change a thing.

So here is the model that works.

Now, this may appear to be a complicated model. But the beauty is in the simplicity of focusing key initiatives to make the system high-performing. Here is the overview:

Cost: Transform the Medical Malpractice system, using Health Courts. This will minimize the impact of defensive medicine, reduce liability costs, and make the error system more rational. Couple this with cost benchmarks for services/procedures to set a standard of financial performance to measure providers and facilities.

Quality: Evidence-Based Medicine is key to establishing a standard of medical performance. Making this a permanent institute will provide a vehicle for pharmaceutical and medical device firms to introduce innovations that make healthcare more cost-effective with better quality outcomes. With Medical Malpractice reformed, this effort will become practical and achievable.

Access: Provide a mandated Low/No Cost Insurance option for all Americans, but use a model that leverages the current private system networks, augmented with public funding, that meets government standards. This will create a rationalization and standard for reasonable levels of healthcare that will be leveraged for the vast majority of Americans. This will obviate the need to create a risky public option while moving most private plans to comparable levels of coverage.

These are the core foundation points. From here, the payment system can be replaced with a Pay for Performance model. Many of the trials of these systems have been successful. Also, creating a separate commission, similar to the Base Realignment and Closure Commission, made up of experts who can establish reimbursement levels for Medicare, is a great idea. This will take the politics out of Medicare, providing cover for Congress. While the desire to implement Electronic Medical Records sounds great in theory, the benefits will be minimal, at best, unless there are standards for data exchange and interoperability. Solving this problem needs to proceed a large-scale technology program. Lastly, creating funding mechanisms for the newly insured must be evaluated against the overall cost of healthcare. If the cost curve bends down, as it will using this model, then some additional government debt is acceptable when viewed against the cost of the whole system. Trying to balance the budget as a standalone measure is foolhardy and will only result in damaging additional taxes.

With all of this in place, we can start to tackle another of the biggest causes of our increasing cost curve: wellness and preventative care. If we don’t begin to make a concerted effort to reduce the health effects of lifestyle in the US, our demand for healthcare will continue at a staggering pace.

This is an overview of the changes necessary. I will discuss each of these steps in greater detail in the coming days. The question remains: When will the Administration and Congress describe their details for healthcare reform?

Oh that’s right. They have. Healthcare for All. Tax the Rich. This is reform? We can do better.