clinical innovation - Health Care Innovation: Govrnment-Down or Society-Up

There's nothing mysterious about innovation - it's niches, sons of niches, and government gliches.

Tongue-in-Cheek Entrepreneur


In the U.S., decisions are based on proximity to performance. The American entrepreneurial economy differs from European economies. American organizations make decisions based on proximity to performance, the market, technology, society, environment, and demographics.

In Europe, on the other hand, distance from the market of centralized systems makes innovation and responsiveness difficult. What separates us from other nations is our individual ingenuity and entrepreneurship, as opposed to government-imposed agendas, which tend to smother innovation.

The recent economic crisis, said by some to be due to lack of centralized regulations, dismal U.S. health statistics, and a U.S political shift to the left, raises this question: Is national innovation preferable to private innovation?



Two “Perspective” articles in the New England Journal of Medicine form the basis of this editorial.

· In the first, Victor Fuchs, PhD, retired Stanford economist, says national reform should start with three “inconvenient truths” as a starting point for national health reform.


1. Over the past 30 years, U.S. health costs have grown 2.8% faster than the rest of the economy.

2. Advances in medicine, mostly secondary to private innovation, are the reason for this 2.8% faster growth.

3. Universal coverage will require national reform and financial sacrifice by the wealthy and healthy and those who afford to pay to pay for the sick and the ill who can’t afford to pay.

· In the second, Karen Davis, PhD, president of the Commonwealth Fund in New York, says we ought to learn from other countries to develop innovative national strategies to cut spending. She cites the following data based on predictive modeling by the Lewin Group. Here I list the data in descending order of spending impact.

1. Establishing a National Center for Medical Effectiveness and Health Care Effectiveness, -368%

2. Promoting public health and disease prevention through new taxes in invested in prevention programs, -293%

3. Instituting Medicare episode-of-care payment, -229%

4. Strengthening primary care and care coordination, 194%

5. Promoting public health by reducing tobacco use through next taxes invested in prevention programs, -191%

6. Limited payment updates in high-cost areas, -158%

7. Limiting federal tax exemptions for premium contributions, -131%

8. Apply Medicare provider payment methods for and rates to all payers, -122%

9. Instituting competitive bidding between Medicare and private plans, -104%

10. Promoting health information technology, -88%


In other words, Big Brother will take care of you through federal innovations: new taxes, new programs, and new regulations. “What is required,” Dr. Davis asserts, “is national leadership and commitment to moving towards a high-performance health system.”

It sounds a bit like All for Medicare, and Medicare for All, with national prevention programs to get Americans to change their smoking and eating habits, and cutting and limiting doctor payments. You can call this innovation. I do not.

References

1. V.R. Fuchs, Election 2008: “Three ‘Inconvenient Truths’ about Health Care, “ New England Journal of Medicine, October 23, 2008

2. K. David, Election 2008: Slowing the Growth of Health Costs – Learning from International Experience,” New England Journal of Medicine, October 23, 2008.

3. C. Schoen, R. Osborne, M, Doty, B. Peugh, J. Murukutla, “Toward Higher Performance Health Systems: Adults’ Health Care Experiences in Seven Countries,” 2007, Health Affairs,(Millwood, 2007.26:w717-w734