Monday, December 30, 2013

We Can Do Better Than This

There is another and a better world.


 I have composed 3200  blog posts over the last 7 years under the blog title of “Medical Innovation and Health Reform.”  As I write these pieces, I find myself saying, “We can do better than this.”

I define medical innovation as doing things simpler, cheaper, more conveniently, and better.  I define health reform as changing things for the better.

In my opinion, current health reform efforts do not meet these tests.  The health law is too complicated, expensive,  inconvenient, and it  has not improved quality.   

We can make it simpler.   

We can trust patients more by encouraging them to have health savings accounts with high deductibles.  They can choose the care they want up to the level of the deductible, and they can set aside money they do not use for health purposes for retirement and other uses.  We could issue a health savings account  to each citizen  at birth and let them pass it on to their heirs. Patients with “skin in the game” use less care and pay lower premiums.

We can make it less expensive by removing third parties from the doctor-patient equation.   Physicians will tell you dealing with third parties accounts for more than half of their overhead.   That is why doctors going into concierge practices can cut their rates by more than half.    We reduce premiums by cutting the number of regulations with which doctors and hospitals must comply.  

We can render it less expensive by making  prices transparent,  posting them in offices and hospitals and on the Web.   We can let  patients shop across state lines for the best price  and the best listed outcomes.  We can make  all health transactions tax deductible.  We can institute  national tort reform, have health courts pay  for medical injuries and make lawsuit-losers pay,  thereby reducing the number of frivolous lawsuits and the high malpractice rates physicians and hospitals must pay.

We can transfer some decision making and patient support to other health professionals rather than doctors and to patients themselves. Nurse practitioners and physician assistants are effective in treating patients.   Patients already can interpret pregnancy tests, glucose and hemoglobin A1C levels,  lipid results, the meaning of body mass indices, and DNA implications.

We can make care more convenient for patients and doctors.   We can let patients choose their own doctor.   We can let patients choose their own health plan.   

We can encourage patients and doctors to make better use of online information technologies.  

The list of ways to do this is impressive and growing  -  convenient scheduling, prescription renewals,  posting of test results through physician websites; email communication between patients and doctors,  encouraging patients to compose their medical histories through the use of clinical algorithms;  having patients carry their medical histories on cards in their wallets and purses; monitoring patients vital signs,  heart rhythms, an complications  remotely through embedded sensors;   evaluating patients  at home and in remote locations through Skype and similar technologies;  and predicting future diseases and impact of treatment based on a person’s genomic makeup.

Tweet: We can make better use of medical innovations, and we can achieve better health reforms than we are now doing