Building a Better National Health System

May 18, 2009

In last month’s column, I discussed how poorly the U.S. is faring in recent rankings of global health care systems. This month, I’d like to propose some cost-effective solutions. By taking significant action on two important fronts, I believe we can provide universal coverage with just a nominal increase in total national spending. First, we must build improvements into the U.S.’s current mixed private-public system. Second, we must invest in better technology to improve efficiency across the breadth of this revised health care system.

President Obama’s administration has proposed a plan that addresses these two important issues. Improving the current mixed public-private system will include maintaining the current role of employer-sponsored insurance while providing for an expanded Medicare system. A significant new entity, the National Health Insurance Exchange, will connect the two systems and help individuals acquire new, affordable health care options if they are uninsured or want new insurance. Income-based sliding scale tax credits will be provided for those who need it, to ensure thorough coverage.

A vitally important element of this proposal guarantees eligibility and covers pre-existing conditions. As a result, everyone, regardless of health status and/or history, will have access to comprehensive benefits at fair prices. This is a significant change in philosophy from our current system, which denies coverage to many applicants with pre-existing chronic conditions. Many uninsured simply opt for no treatment until a crisis happens, and then they resort to using emergency rooms as clinics, further stressing an already stressed ER system, and driving treatment costs far above what they would have been had the pre-existing condition been treated properly from day one.

The second element of this plan aims to improve efficiency across the health care system. Providers in other countries have plugged into the latest e-sharing technologies, but many of our nation’s caregivers still rely on hand-scrawled notes. Standardized electronic health information systems will help providers coordinate care, measure quality and reduce errors, with plenty of room for encryption codes to ensure patient privacy.  A study by the Rand Corporation found that if most hospitals and doctors adopted electronic health records, up to $77 billion of savings would result.

Another significant part of the plan allows flexibility for state health reform plans. Several states have taken lessons from Switzerland and the Netherlands, which both offer successful examples of standardized benefits plans combined with tight regulation of insurance markets. Massachusetts, for example, has already adopted some of these concepts, and alternative options are being considered by other states and federal policymakers. Allowing states to continue exploring alternatives helps build a groundswell of innovation that is desperately needed to help our system become more competitive and efficient.

One such innovation is the "medical home," which integrates the concept of the old-time family doctor with a whole-person approach to specialty care through networked teams of specialists in a collaborative environment. Led by a patient’s personal physician, a team of individuals at the practice level collectively takes responsibility for a patient’s ongoing care, including all stages of life: acute care; chronic care; preventive services; and end of life care. By integrating all elements of the health care system (e.g., subspecialty care, hospitals, home health agencies, nursing homes) with the patient’s community (e.g., family, public and private community-based services), we achieve a far more logical flow of care than today’s expensive, fragmented, specialty approach.

My point is that, as business people, we should be on the front lines of the struggle to improve our bloated, overly-complex health care system. We should be willing to support an open and ongoing conversation on how to reduce projected trends in health spending.  Why? Because the consequences of ever-soaring costs, combined with eroding coverage, can and should not be allowed to overwhelm our economy, especially when viable solutions are possible.

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