Friday, April 8, 2011

Six Health Reform Insights

A moments’ insight is sometimes worth a life’s experience.

O.W. Holmes, The Professor at the Breakfast Table

April 8, 2011- Today my website,, goes online. What do I hope to accomplish with this act of egoism? Other than to spread the word of my existence and to direct people to my blog, medinnovation, I hope to give readers self-evident insights into what is going on beneath the surface of health reform.

One – Health reform is about saving Medicare and Medicaid . These twin entitlement programs are eating federal and state budgets alive and are the single greatest contributors to the U.S. budget deficit.

Two - The soaring deficit gives vivid testimony to that hackneyed cliché, “There is no such thing as a free lunch.” The burden falls on taxpayers. Those unloading the economic wagon exceed those loading it. The takers will soon outnumber the givers.

Three - Government management of patient and physician expectations verge on the impossible because disease is emotional , personal, and sometimes tragic and is a mixed stew traceable to unhealthy behavior and Acts of God.

Four - To ultimately control costs will require transferring enough costs to inform health care consumers and patients to sensitize them to true costs and value to help them decide between competing physicians and health care organizations.

Five - No single reform solution works. Top-down solutions - herding doctors and hospitals into integrated groups like accountable care organizations (ACOs) or monitoring through pay-for-performance (P4P), electronic health records (EHRs) – has flaws. So does market-style and consumer driven reforms , as evidenced by the U.K experience (M. Roland and R. Rosen, “English NHS Embarks on Controversial and Risky Market-Style Reform in Health Care,” New England Journal of Medicine, April 7, 2011.

Six - Reform hinges on ideologies - government vs. markets, collectivism vs. individualism, capitalism vs. socialism, globalism vs. nationalism. These conflicts date back to Bismarck’s social welfare programs and extend through FDR, Truman, Nixon, Reagan, and Obama. These muddles will be resolved through a hybrid model in which pragmatism trumps ideologies.

No comments: