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As a veteran of more than a couple of decades of working in the healthcare industry, I have always been struck by the Tale of Two Cities story of healthcare in America. By that I mean it is the best of times for some, and the worst of times for others.
Our technological capabilities are astounding, with advanced microsurgery, nanotechnology interventions, a plethora of pharmaceuticals and amazing imaging systems. In virtually every area of the country, highly trained paramedics supported by advanced telemetry and helicopter transport respond to medical emergencies. Hospitals have moved with much of the population to suburban areas where they provide birthing centers, ambulatory surgery, diagnostics and state-of-the-art treatment capabilities. For those in America with access to this system, it is truly the “best of times.”
On the other hand, accessing the system is fraught with problems. While essentially every American over the age of 65 is supposed to have access to our healthcare system, many have a hard time finding a doctor willing to accept Medicare reimbursement. Medicaid recipients, the poorest members of our society, face an even more difficult task in getting access to care.
For hard-working Americans whose employers choose to not provide health insurance, our healthcare system is out-of-reach, as it is for many immigrants. Despite spending approximately 16% of our country’s GDP on healthcare, our system has become all but inaccessible to far too many in our country—leaving those dealing with a serious illness in the “worst of times.”
THREE MUST HAVES
What can be done to provide more people with the best of times? There have been many good ideas put forward. I suggest three critical components of a successful national approach, as follows.
Everyone should have equal access to our healthcare system. The approach of having an employer-based funding system doesn’t work and should be replaced with a tax-credit that covers the full cost of an insurance premium. The Federal Employee Health Benefit Plan (FEHBP) could be expanded as the mechanism for offering competitive health plans across the country. If it works for federal employees—why not for the rest of us?
Medical homes are an essential element in a fully accessible and integrated system of care. Unfortunately, this is not reflected in reimbursements for primary care services. The medical home concept should be enhanced with an appropriate monthly patient case management fee coupled with practice performance incentives for primary care providers.
The federal government’s role should be as an objective regulator of quality and performance for each plan, as well as serving as the central point of regional rate negotiations. The government should also capitalize the development and implementation of systemwide infrastructure, clinical research and best practices.
While each of these proposed components would garner supporters and detractors, I believe we all agree that we have to do something that opens the system to everyone—in an affordable and achievable way.
It would be a sad indictment of our industry if the only way to improve our system is to have Congress do it. Do we want to remain a Tale of Two Cities system of care, or do we really want the best of times?
Don Hall, a former health plan CEO, is principal, Delta Sigma LLC, in Littleton, Colo.