Thursday, July 26, 2007

Future - The Vision Thing

Pretend you’re driving a futuristic health care car called “the vision thing.” It’s your vision of how things ought to be.

Your car has three mirrors – one left, one right, one middle. You can view the road ahead through all three. Your mirrors, save for the middle one, are totally transparent. Nothing obstructs your ideological vision.

Computers steer your car. They sense every dip in the road, every curve, every piece of ideological debris that might veer you off course. Computers in your vision thing will take you straight towards a more perfect health system.

In your left mirror, you can see clearly where you’re headed – towards a compassionate, government-run, tax-supported system covering everyone - with no fiscal concerns, nothing in limbo, no care stone left unturned. It pays for all.

Though a side window, you can see you’re nearing your destination. Through Medicare, Medicaid, and now Schip, your government already pays for over half of health care costs. The only things left to done and paid for are covering the uninsured, all adults before 65, and all long-term care for the elderly.

The future is clear. Washington-based pundicrats, politicrats, technocrats, and other carecrats – each with the wisdom of Solomon – will guide care for less knowledgeable beings on the ground. These wise ‘crats will know what you need -- and what government can afford to pay. Citizens will be entitled to everything , and government will have enough resources to cover the healthy -- but not all of the sick. The sick will have to wait for certain optional high tech services –expensive drugs, cancer treatments , kidney dialysis, joint replacements, heart bypass or stents. The healthy, 90% of the electorate, won’t object, for they will believe in the end government will protect them against all that may come.

Your chances of becoming ill or dead will drop. The government will set up a Preventive Care Agency (PCA) to assure every preventive care measure is carried out. Government will create a Best Practices Agency (BPA) to guarantee doctors and hospitals follow best practice guidelines, practice Evidence-Based Medicine (EBM), and pay doctors be paid for performance (P4P), performance being defined as meeting all quality indicators. No “grays,” clinical uncertainties, or“idiopathic” thinking , will be allowed. All will be black or white.

Government will insist all doctors be salaried in large groups, where they’ll be monitored for compliance with guidelines and safety standards. Concern over drug costs will disappear. The government will negotiate prices for drugs and everything else, health costs will fall, and care will be “free.”

Your chances of becoming ill or dying from over-eating, over-drinking, over-smoking, and under-exercising will plunge. Government will heavily tax and, in other cases, prohibit or make prohibitively expensive junk foods, trans-fats, cigarettes and alcohol beverages, and it will reward those who wear ankle-bracelets containing computer-monitored pedometers.

In the right mirror, you can visualize a pure market-driven system. In it, health care consumers, spending their own money, given perfect “metrics” on consumer satisfaction, convenience, quality, outcomes, and prices, will have the data and Internet savvy to sort out health care choices. Consumers will have high deductible accounts, HSAs, and total market transparency. They will know upfront what things cost, just as in any other market. Computer feedback from other consumers will allow them to know how others rate the quality, convenience, and satisfaction of providers. Consumers will pay for care with debit cards at the point of care, and there will be no third party to reject claims. “Compatibility” computer systems, similar to, will match consumers with high performing doctors and hospitals. .

Choices will abound. Innovators and entrepreneurs will offer and develop a myriad of services to fill niches and gaps in health care. These services will be near where you work, play, and retire. Developers of new services will ask. What do health care consumers need and want? How can we satisfy these needs and wants with cheaper, more convenient, easy-to-understand, , and more effective care? What will consumers be willing to pay for? How can we make money?

Critics will protest you can’t trust markets and the profit-motive in health care. Patients aren’t smart enough, they will say, to shop for health care, and health care woods are full of commercial predators preying on the sick and gullible . Proponents will say markets adjust in the end, and consumers will weed out outliers and out-right-liars.

The middle mirror blurs ideas from left and right. It depends on compromise and collaboration, and may entail collisions. Critics may assert everything will change but the status quo, which may not be too bad, if given in the spirit of quid pro quo.

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