Universal coverage is an important objective for our society. To achieve it we must broaden the current debate now largely limited to insurance reform and address the root causes of our expensive health care system.
Expanding coverage without initiating real change, as CBO projections demonstrate, is unaffordable. The health insurance future obligations to retirees of many state, federal and local governments, if reported, would show most are already bankrupt. Insurance reform alone is insufficient to address the challenge of future health care costs.
Impartial experts have recommended a number of changes to "bend the curve" of projected health care costs and thereby create affordable universal care. Here are some of the most important:
Develop an alternative dispute resolution system. Experts disagree widely on the societal cost of medical liability. Trial lawyers argue the cost of medical malpractice is less than 1% of the national health care dollar. Most health care professionals disagree and cite a 2003 Health and Human Services study that concluded medical malpractice premiums plus defensive medicine practices combined account for 10% of all health care expenditures. The current system of court adjudication of malpractice lawsuits is inefficient, expensive, wasteful and poorly serves providers and patients alike.
Remove barriers to new, more efficient models of care. Hospitals are places of medical miracles and dedicated, caring professionals but the hospital model is structurally inefficient and costly. Were it not for a variety of subsidies, philanthropy and a host of regulatory protections, many hospitals would fail.
The solution to high hospital costs is not better hospital management; it is alternatives to the model itself. Twenty-eight states still protect hospitals through cumbersome Certificate of Needs laws that stifle new care delivery models without demonstrable benefit for their citizens.
Promising new models of care struggle to emerge because of congressional moratoriums, status quo reimbursement practices and cumbersome regulatory requirements. The collective rules known as the Stark laws prevent physicians and hospitals from entering into gain-sharing arrangements whose goal is to improve quality and reduce costs.
Prudent health care reform must include the removal or modification of the many government regulatory barriers that stifle the emergence of lower cost models of care.
Change fee-for-service to fee-for-outcomes. We should establish bonuses for quality; encourage Accountable Care Organizations that integrate physicians, hospitals and others around achieving quality and cost reduction targets.
Promote business models that tackle chronic disease. Fee for service does not work for this population, which consumes more than 50% of health care dollars.
Increase the nation's capacity to produce qualified health care providers. We are critically short of the physicians, nurses and technicians needed to provide alternative care delivery models.
Encourage a price-sensitive health care purchaser. Unbundle insurance coverage into its component parts with high deductible "true insurance" for high cost medical treatments coupled with health savings accounts for lower cost health services. This approach encourages consumers to spend their health dollars wisely. Currently fewer than 10% of Americans are covered by this approach.
Collapse multiple coverages -- workers compensation, automobile and liability -- into one system. Stop duplicate coverage.
Provide incentives for healthy lifestyles. Some of our medical treatment costs could be prevented by better personal choices. We are an obese nation and obesity predisposes us to preventable illnesses.
To make health care affordable for all Americans, the health care industry must be disrupted in a way that permits lower cost, high quality alternatives to emerge. Such disruption will not come from existing providers of services. It will come from new entrants, new competitors. Universal coverage is a noble aspiration, but it cannot be affordably achieved by insurance reform alone.
Let's hope the Obama administration and Congress will the lead the way to a broader discussion and responsible next steps dictated by prudence rather than politics or an arbitrary timeline.
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