Health Care Reform: Where Do We Start?

I can send a birthday card from N.C. to a friend in California in about three days for 44 cents or register my car at the Division of Motor Vehicles in five minutes. Yet the U.S. Postal Service and DMV are the poster-child examples of critics who say the government that produced them can't possibly fix our broken health-care system. I think it’s time to shelve this old, tired argument and instead devise a plan to insure more Americans, control costs and actually improve our citizens' health. That's a goal I think we all can agree on.

Surely, people of all political stripes can agree that it's wrong for someone in America to die simply because they lack health insurance — like the cancer patient denied life-saving chemotherapy because they’re uninsured. No one argues the system isn't broken or that costs aren't out of control. The debate is over the cure. From my experience helping patients and employers navigate the health care system, these are the key issues that I believe any reform plan must address:

• Increasing personal responsibility: Since nearly 60 percent of all health care problems are lifestyle-related, Americans need to pay a larger portion of the costs of their own choices. Only then will behavior change.
  


• Breaking the health care/employment bond: Although the norm since WWII, job-based health insurance no longer meets the needs of a highly mobile workforce.
  


• Eliminating tax breaks for health insurance benefits: The revenue from eliminating tax-free health would go a long way to providing coverage for the estimated 45 million Americans without insurance.
  


• Shifting Medicare's focus to preventing disease: Too much is being spent on the last six months of life instead of earlier in life to head off disease: money for preventive care, early childhood care, immunizations; nutrition, health education and dental care. Finding a way to get folks aged 55-64 into Medicare — a high-utilizing group with pre-existing conditions — would also help close the insurance gap but must be similarly accompanied by a shift to more preventive care earlier to control costs.
  


• Ending first-dollar coverage: We want an MRI for every headache because we don't pay — and complain even about our $20 co-pays. It's only when market forces determine costs that costs rise and fall. That's why facelifts still cost about the same today as they did five years ago. Applying the same logic to health care and considering health care like homeowners or car insurance would save billions. We pay for regular oil changes; insurance pays if our car is totaled.
  
  
• Rewarding quality over quality: The Mayo Clinic, one of the nation's most-respected health care providers, is also a low-cost provider because it's a not-for-profit hospital where physicians are salaried and not incented to order more tests or perform more procedures. Not surprisingly, the area with the highest health care costs per person is McAllen, Texas, which has a higher concentration of for-profit and physician-owned hospitals.

I agree with Atul Gawande who provided that illustration from McAllen in an article on health care reform in The New Yorker. No financial incentive to do more really does equal better health care and lower costs. To put us on a different course, he recommends a national institute for health-care delivery, bringing together clinicians, insurers and employers to identify and implement the strategies that produce the best results and put the focus where it should be.

Runaway costs are the wound that has our health care system on life support. It's time to work together to stop the bleeding before it's too late.