As has almost become the rule, comprehensive health care reform is likely to be shoved to the back burner as other issues, seemingly more pressing, rise to capture the attention of political leaders. Don’t let it.
Conventional reasoning is that no money exists to reform health care, but that fact actually opens the door, doesn’t close it, to the type of structural reform that is so badly needed.
The fundamental issue that ultimately drives everything else (including the magnitude of the uninsured) is the inexorable, unyielding rise of heath care costs, and spending, that far outpace wage growth.
Yes, affordable coverage for every American must be the goal, but it cannot be achieved and maintained if we don’t bend the cost/spending curve. So with little “new money” coming into the system, let’s direct laser-like focus right now on the mission to increase value in health care.
Everyone agrees that gross inefficiencies in health care — including the waste from inappropriate care, the irrational regional practice variation, the tolerance of nonevidence-based diagnostics and treatments, and the duplication of services attributable to a lack of a “systems approach” — lead to recurring and unpardonable waste of as much as 30 percent of current spending.
So if we are smart about it, and we apply the vast potential of 21st-century information technology, we can rechannel the vast resources currently wasted to improve health and extend health coverage. We can convert our disconnected health “sector” into a “system” that can be managed with an alignment of incentives of all players around improving the health of individuals.
The president will be distracted by the economy in the short term, but the administration can lead, and I’d argue must lead, to make health a priority. Congress should take the initial leadership in establishing the foundation for reform. Congress should build in a bipartisan way on what it already knows, but also bring in the new administration early and demand presidential leadership each step of the way.
Despite 20 years delivering health care to individuals here and overseas, and 12 years in Congress working on the policy of health care, I certainly don’t have the answers, but I do have the following suggestions that I am confident will effectively and quickly get the ball rolling.
1. Information Technology. Speed it up; this is the no-brainer.
The last administration made real progress, but they discouraged Congressional legislation, thinking they could do it on their own. This requires legislation.
Two things must be done: Establish industry-wide interoperability standards (“the gauge of the railroad tracks”) and provide modest, short-term economic incentives for physician adoption. The doctor is the bottleneck today because, ironically, in the near term, IT decreases a doctor’s productivity, and thus income. Help get the doctor over this hurdle. IT enables transparency, accountability and efficiency, and eliminates medical errors to improve quality and reduce costs. Move quickly.
2. Spending and Medical Practice Variation. Leverage Medicare reimbursement to reduce the fourfold variation in spending for the same procedures for comparable patients among different parts of the country. Hang the telling and colorful Dartmouth-Wennberg map of the United States that graphically displays this outlandish variation on the wall of every Congressional health-related committee room.
Yes, some states will have to face up to the fact that their spending, driven up by perpetual and irrational regional practice patterns, is too high. Start now to correct this and you can travel an equitable and well- tolerated glide path of correction over five years. This alone can save as much as 10 percent of annual spending in Medicare.
3. State Children’s Health Insurance Program and Medicaid. You know what you are going to do here already, but put in the legislation a lot more emphasis on aggressively enrolling the 5 million kids who are already eligible for SCHIP. The program has been a huge success as designed, so fully implement it! And the 5 million uninsured who are today eligible but not enrolled in Medicaid (or other government programs) should be enrolled as well. States are going to avoid this, so federal incentives and direction are critical.
4. Tax Policy. Stop taxpayer subsidies that encourage expensive overutilization of medical imaging, diagnostics and treatments. Restrict the size of the tax advantage on employer-sponsored health plans to an actuarial value of an average type of health plan, rather than have the taxpayer subsidize the gold-plated expensive plans offered by well-meaning employers. Use these tax savings to begin leveling the playing field between those who buy individual plans and those who buy employer-sponsored plans.
5. Legislation. For those in Congress who are not on the health committees, I humbly encourage you to begin your study with the Wyden-Bennett health plan, just to jump-start the broader discussion of health reform. It isn’t the end-all answer, but it provides enough modern, bipartisan transformational components to be a good starting point for the new Congress and administration to establish a common dialogue. Both the House and the Senate leadership should consider in January setting up health study groups and beginning hearings on this bipartisan plan.
6. Surgeon General. Move early with a surgeon general. The process unfortunately often gets political, but we need to get over it. The No. 1 factor determining an individual’s health today is not type of insurance or who your doctor is; it is behavior. Obesity is an epidemic that is tearing apart our nation’s health, and we need a “nation’s doctor” whose voice speaks loudly on this issue to every community and constituency every single day.
7. Biomedical Research Funding. Don’t make the mistakes of the last decade (I am guilty!) of doubling funding of the National Institutes of Health over five years, then immediately starving it with an effective 3.5 percent cut annually over the past five years. Begin to invest consistently and positively in the future without these destructive jerks of on-off funding, which create huge gaps in human capital and flow of science. Our science is one of our few competitive edges, and we are at risk of losing it.
We won’t see comprehensive reform in the next Congress, despite the pressures of campaign promises, a skyrocketing average cost of employer-sponsored coverage of more than $12,800 or the 45 million uninsured. Why? Because we don’t have the money, there is not yet consensus around what comprehensive reform should look like, and the powerful stakeholders of the status quo will resist change.
But the foundation can be set; the knowledge- based tools to bend the cost curve can be applied. The suggestions above are a starting point. We can advance the goal of maximizing value in health care delivery, open the door to continuous quality improvement, redirect existing monies to where they can do the greater good and define the platform for a time when we can proudly say that in America, every American has affordable access to quality health care.
Former Sen. Bill Frist (R-Tenn.), a practicing heart and lung transplant surgeon, served as Majority Leader from 2002 to 2006.
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