President Obama should be commended for addressing the challenge that’s facing our nation’s health care system. While Democrats and Republicans agree that the health system is broken (since 1975, per person annual health spending has grown 2.1 percent faster than overall economic growth per person¹), there is no clear agreement on the next steps that need to be taken to fix the problem.
President Obama has offered the idea of implementing a national health care plan; however, in its current iteration, his plan doesn’t address what’s broken with the system. Instead of flooding the system with 46 million more insured persons and spending $1.2 trillion over the decade, Obama should look to the hard evidence that indicates a third of all health dollars currently spent each year (more than $750 billion) are wasted. That lump sum should be brought back into the system to care for the uninsured and reduce the national deficit at the same time.
To reclaim those lost dollars, we need to evaluate the emerging value-based health care space.
For background, value-based health care plans have three components:
- A special plan design that rewards high quality care by patients and their physicians
- A system for information exchange such as an interactive personal health record that highlights exactly for each person (and their physician) what their recommended care actions are and what is missing! and
- Decreased premium for patients and better payment for physicians and hospitals.
For physicians and patients who participate in value-based health plans, each person must comply with CDC guidelines for disease prevention and management. For example, diabetic patients not only need care for diabetes, but also for early cancer identification and immunizations to prevent infectious diseases. Each individual and their physicians have online access to a personal health record that enumerates gaps in compliance with care. Using this tool – which is available today – patients essentially have a to-do list that helps them close the gap.
For the example above to work, we must recognize that health, like democracy, requires active participation of all our country’s citizens. Our government does not work when we fail to vote. Likewise, our health system cannot work if we fail to actively participate in taking care of ourselves.
And while legislation is one important way to change behavior – e.g., the motorcycle helmet and “Click it or Ticket” laws are two successful examples –we must also educate and incent payers and payees into participating voluntarily. We need both carrots and sticks for success.
The paradox is that in value-based plans, people see their doctor more frequently while overall medical expense decreases (and overall health increases). With this ounce of prevention, individuals can be made aware of potential medical problems before they become life-threatening. Imagine if your doctor said, “At the rate your blood sugar is rising, you will more than likely contract full-blown diabetes in the next year.”
As such, part of any value-based reform campaign must involve education that reminds people how many Americans (with or without insurance) face bankruptcy because of preventable health catastrophes. In short, we must put in real terms how much money Americans will save by staying healthy using value-based plans.
Like “click it or ticket,” just by following the rules of the road for health and using available technology, each person and their physician can recover one-third of a trillion dollars a year for America starting today. That’s reform we can believe in.
1) Council of Economic Adviser’s Executive Summary, “The Economic Case for Health Care Reform,” June 2009. http://www.whitehouse.gov/assets/documents/CEA_Health_Care_Report.pdf
Dr. Kardos is the former Chief Medical Officer for Horizon Blue Cross and recent past Chairman of the Board of AT Still University. He founded Triveris 18 years ago to reduce health costs by improving medical care quality using information exchange and low cost available technology. He is a fellow of the American Academy of Pediatrics.