To fix our economy, we must reform health care delivery

The dominant political debate of the day regards the form of tax legislation needed to prevent major tax increases beginning in January 2011. Underlying this debate is the weakness of our economy and the loss of employment for so many Americans. There were many drivers of the economic “melt down” in 2008 but one that has gone out of focus recently is the tremendous burden of health care costs. And with the passage of last year’s health care reform legislation (PPACA), costs will increase even more. Regardless of the outcome of new tax legislation and potential stimulus spending, deficit reduction remains a necessary yet menacing challenge. What needs to be discussed more rationally and addressed quickly is how we stem the continued escalation of health care expenditures, particularly with the passage of PPACA and the increased coverage of many more Americans.In an editorial in this Sunday’s New York Times, this issue is discussed with a primary focus on reducing costs by cutting Medicare expenditures and increasing the costs borne by individuals. Neither of these approaches gets to the root of the problem. Lowering overall expenditures for health care must be addressed as our current weakened economy is straining under this burden. Importantly, it is feasible to both lower costs and improve care! PPACA, while monumental in its scope, focuses largely on insurance coverage but deals lightly, and in my view ineffectively, with the root problem of health care delivery in the US. Our health care delivery “system” is uncoordinated, reactive, and focused on the expensive treatment of disease events associated with late-stage preventable chronic illness.

Physicians and providers are currently rewarded economically for interventions, particularly invasive ones. It is recognized that coordinated care which emphasizes prevention and, when needed, interventions over time, and is focused on a motivated and involved patient, provides the most cost effective outcomes. Reimbursement for prevention and coordinated care to minimize disease is insufficient to cover costs. Yet reimbursement must be structured to reward such care.

PPACA addresses these issues, but the solutions require the establishment of new bureaucracies, many years, and changes that will be subject to intense political debate. The type of care needed to improve health, outcomes and decrease costs is well understood today, but little is being done to foster its adoption. Care must be coordinated, personalized, preventative, and involve an engaged patient. Unfortunately, current incentives work against such models of care being established. I don’t see a timely solution, given the current approaches.

To foster change, I propose highlighting the imperative to do so along with the establishment of a bipartisan Presidentially-appointed committee charged to recommend new models of coordinated care delivery and reimbursement strategies. The Bowles-Simpson Committee is an example of a bipartisan approach to recommend solutions to knotty problems. The report of a Health Delivery Improvement Committee could be expected within six months. Both private insurance and CMS could provide reimbursement incentives to foster recommended changes rapidly. The answer to our current wasteful approach to health care will be far easier to find than overall solutions to a tepid economy, but the former will provide strong support to make the latter solution easier.

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