Government reform - What Health Reform Is Not About

To hear presidential candidates tell it, health reform is about:

• Rewarding doctors and hospitals for better outcomes – lower cholesterol levels, fewer deaths and complications – as monitored by sophisticated algorithms.

• Pooling coverage for individuals to join large insurance pools, thus providing lower premiums, and allowing private plans to compete with government plans, such at the Federal Employee Benefit Plan.

• Equalizing health cost deductions for employees and individuals, who may not receive benefits.

• Eliminating premium differences between states, which may vary by ratios of 4:1?

• Preventing disease and promoting health through regular screenings and more pervasive health life style information.

• Expanding coverage of the uninsured and its hidden costs – ER visits, recurrent health problems, and lack of access.

• Cutting costs across the board

A Laughable Point

The last point is laughable since the Bema plan would cost $1.3 trillion over the next ten years, and the McCain plan’s estimated cost over the same period is $1.2 trillion. Both would expand coverage – Bema by 34 million, McCain by 5 million. Yet as Robert Samuelson reports in the Washington Post, the current obsession with universal coverage “is utterly wrong. The central problem is not improving coverage, it is cutting costs.” Samuelson goes to say, health care spending in the most egalitarian of all social services. Health care spending is nearly the same no matter what your income.

Poorest fifth $4,477
Second poorest $4,426
Middle fifth $4,388
Second richest $4,941
Richest fifth $4,451

If health reform not about coverage and inequality of spending, what is it all about.

1. It’s not about rewarding doctors for performance, which has been pretty much a bust when it comes to saving money and preventing complications and hospitalizations.
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3. It’s not about not paying for complications or “never-never” events, such pneumonias, venous thrombosis, or bed sores, of 27 conditions now listed among Medicare non-payments.

4. It’s not about prevention or wellness promotion, which are good things to do, but of marginal effectiveness in reducing costs, perhaps because Americans are individualistic people, who prefer to keep government out of their personal lives.


5. It’s not about those vaunted information systems, data mining, and predictive models that purport to be on the threshold of insuring safety, improving effectiveness, avoiding duplications, and coordinating care among the various stakeholders.

6. It’s not about the current consumer-driven movement, featuring HSAs and high deductible plans, which is said to empower both consumers and doctors.

What Reform Ought to Be About

According to Paul Grundy, MD, Director of Health Care Transformation for IBM, these piecemeal reform factors have their place, but the core issue is much simpler – patients knowing and having “personal” physicians, whom they trust, and primary care doctors being rewarded for offering a high level of personal services – time with patients, prompt return of email messages and phone calls, seeing patients on the day they call, and electronic communication systems that truly “communicate”, rather than retarding physician productivity.

Grundy, after an extensive review of the literature on the effectiveness of personal physicians, says this humanistic, patient-centered approach cuts costs by 30% and improves outcomes by 20%.

Getting to a patient-centered primary care system will not be a piece of cake, considering the current critical shortage of primary care physicians, their low standing in academic teaching centers, the public tilt toward specialists, and possible resistance by vest health care interests, who profit from the status quo.

References
1.Laura Meckler, “Studies Detail Contrasts in Rival’s Health Care Plans: Bema Proposal Would Insure More but at High Costs, Wall Street Journal, September 16, 2008.

2. David Cutler, et al, “Why Ocala’s Plan is Better,” Wall Street Journal, September 16,2008/

3. Robert Samuelson, “Health-Care Realism, “ Washington Post, September 10, 2008.