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Proposal for a THCB Healthcare Reform Effort

THCB regular reader Deron Schriver wants THCB readers to suggest plans to reform the health care system. Here’s his appeal:

I enjoy many of the discussions on THCB.  Intelligent people from all vantage points of the health care system congregate to engage in conversations about the most important issues out there. What if there was a way to translate those discussions into treatment plans for the ailments of our health care system?

Meaningful, sustainable reform can only come from a collection of people from the various stakeholder positions (physicians, patients, insurance companies, employers, etc.) who see what’s working and what isn’t on a daily basis. Politicians do not have the exposure to the system that is needed to prescribe effective solutions. However, they are in a good position to assist in the implementation of well-designed solutions.

We need to approach reform much like a physician approaches an ill patient. That involves obtaining some history, examining the system, and then prescribing a treatment plan. It would require a progress note, similar to what a physician uses, in order to document our work. After all, “if it wasn’t documented, it wasn’t done”.  All problems considered should be discussed by all stakeholders until solutions are developed that 1) are thorough, 2) treat the problem and not the symptoms, and 3) are not zero sum. We need to follow the system all the way from the time the patient enrolls in an insurance plan, to the time she is treated by her physician, to the time the claim is paid (or not paid).

If you have experience with our health care system in some way, whether
it is as a patient or physician, employer or insurance broker, my plea
is this: Let’s continue engaging in thoughtful discussions about
reform, but let’s do so with an end game in mind. What if the
discussion got past the “What caused it?” and “Who’s to blame?”, and
progressed to the “How are we going to fix it?” and “Who is going to
help?”  With all stakeholders involved, it’s easier to ensure that all
angles are covered. 

As I said, I do not believe that our government is capable of devising
the solution we need. However, the government will prove useful in
implementing a solution because it’s likely that certain aspects of any
meaningful solution will involve elements that must be enacted into
law. 

Other reform efforts have produced proposals that do not
completely address the multidimensional nature of the problem, or do
not provide practical ideas for implementation. Our deliverable will
be a non-partisan solution that can be presented to our elected
officials, medical societies, and all other necessary entities to
obtain buy-in and plans for implementation. We have a duty as citizens
to contribute to the well-being of our society and our democracy.

While it seems like an overwhelming task, we really have nothing to
lose because we’re already talking about these things. If Matthew and
Sarah are willing to provide the medium, why don’t we have some fun
with it and see what happens?            

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Mike MJane JacobsGregg MastersPeterDeron S. Recent comment authors
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Jane Jacobs
Guest

Sorry I got away from this thread and am slow to respond. One solution to Mike’s question about for-profit insurers, is the idea of the “Federal Health Board” that would provide some oversight (similar to the Federal Reserve) for health care. Now, there are pluses and minuses to this (as there are with any proposal) but I think it is worth taking a serious look. A discussion about this is going to take place in March when the Medical Banking Project and Mayo Clinic Health Policy Center host a panel at the Medical Banking Institute. More information can be seen… Read more »

Peter
Guest
Peter

Mike, you might want to look at Blue Cross/Blue Shield. They are “non-profit” and operate in many aspects worse than the for profits. Much of their “profits” go to bonuses and compensation. They don’t operate for the patient any more than the for profits – believe me, I’m an ex BCBS insured. They operate under the shield of non-profit just like many hospitals, in a way that no one can tell the difference.

Deron S.
Guest

Great points. I like the idea of a systems approach. Too many people are looking for a quick fix these days. The approach you described would be more methodical and easier to measure the results of specific actions.
If you don’t mind, I’d like to mention your post in my blog. I don’t have the exposure of THCB, but I’m slowly working on getting discussions started about reform. When I hear or see good ideas, I like to build on them.

Mike M
Guest
Mike M

I agree 100% that change must happen. Because of the complex economic issues at play, I strongly believe that the most reasonable first step is drastic overhaul of the insurers. One of the big problems with system change is that it is so complex you cannot measure the effect of multiple changes easily. As in systems engineering I would advocate a gradual introduction of change – change one variable at a time and measure effect. Nobody really believes that for profit insurance really brings much added value to our health care system. Therefore start with leveling playing field by regulating… Read more »

Deron S.
Guest

To be honest, I’d like to see a compromise. I’m not pushing for single-pay healthcare, but something has to change with our current health insurance situation. I wouldn’t mind seeing all health insurers being not for profit entities with limits on executive compensation. That would limit the amount of money leaving the healthcare system in irresponsible ways. Even more importantly, the complexity of our health insurance system has to be reduced. I would like to see medical policy and coverage standards across all payers to reduce the unnecessary complexity. We still have remnants of managed care hanging around that have… Read more »

mike M
Guest
mike M

For Deron and Jane How do the academic and policy experts perceive the role of For Profit Insurance in the future? Will a singer payer allow these parasites on the health care system to whither away or will they be running the show as surrogates for the government? To not openly challenge the role of for profit health care and focus on EHR, physician malfeasance, and promoting wellness is foolhardy. The insurance industry has the biggest lobbying efforts and unless grassroots efforts take place they will have the biggest say at the end of the day. Insurance reform more than… Read more »

Peter
Guest
Peter

“It’s the excessive multi-million $$ judgements where the patient ends up getting rich off an honest mistake. It’s absurd and it needs to stop.” Mostly mythe to think unharmed people run away with million$. If this is the case then docs should get better lawyers. The cost to get these to court is very expensive for lawyers but these have very little impact on overall health costs. This issue is mostly an annoyance issue for docs – I think. But if we had single-pay then that would at least cover the medical bills from mistakes/malpractice, and take that off the… Read more »

Deron S.
Guest

Jane – I will be in touch because that is a great strategy. It’s time we consolidate reform efforts in this country, because reform is just as fragmented as the healthcare system itself at the present time. Peter – Couple quick answers: “Bankrupt? Malpractice insurance? Now look at it from the patients side, who pays them for your “mistake”? Do docs get a free ride while patients are left holding the medical bills?” Very good and very important question. The patient shouldn’t be stuck with medical bills resulting from a physician’s mistake. That’s not the issue because malpractice insurance is… Read more »

Jane Jacobs
Guest

Peter: You raise so many good points, and I don’t think there are any “here is the exact answer” answers at this point in the discussion. Clearly, if the payment system (both public and private) is changed to reward providers for value (better outcomes, safety and service) there will be an immense cost savings — and an incentive for the delivery system to change as well. We currently have in Medicare a system that pays the most to areas of the country that have the worst outcomes. The data that shows this already exists. Check the Dartmouth Atlas — in… Read more »

Peter
Guest
Peter

“We are in a high risk specialty where a simple mistake could bankrupt any one of our physicians. Imagine if you made a mistake at work that could bankrupt you. It’s frightening and it’s unfortunate.” Bankrupt? Malpractice insurance? Now look at it from the patients side, who pays them for your “mistake”? Do docs get a free ride while patients are left holding the medical bills? “I can tell you in all honesty that none of our over-utilization is the result of greed. Not every practice can say that.” So how do we get the “greed” out of the other… Read more »

Mike M
Guest
Mike M

Thanks for the opportunity to communicate regarding Health Care reform. As a physician, I have been increasingly concerned that the biggest problem facing physicians regardless of specialty is not Medicare, malpractice or Justice Department reform efforts. It is Private Health Insurance Corporations. Our citizenry do not realize that We are the only major nation state with a predominant for profit health care insurance system. More than any other variable, this explains the disparity in access and perceived lack of value in our system versus other developed nations. In good times and bad their profits are predictably excessive and achieved at… Read more »

Deron S.
Guest

Peter – Judging by your tone, it seems like you think you caught me off guard with your questions. These are things I’ve been thinking about for years. I think your questions are all fair and this is the type of conversation that needs to happen more often. All practices should have to answer these questions. “How will your medical group cut overutilization, and unnessessary intervention and treatment? Will your group accept less billings?” We do fairly well and we monitor it through chart reviews, but I would be lying if I said there was no over-utilization in our practice.… Read more »

Peter
Guest
Peter

Jane, I went to the web site, good points all, but who will carry the big stick to get it all done. Many of the improvements and changes you list are also concerns in Canada’s single pay system, but even there difficult to enact and get co-operation from all caregivers. As for your, “Provide Health Insurance For All” that would be possible IF the government just agreed to pay providers the same returns and price increases they are getting now as in the MA plan. As I have said “Don’t mandate me into a grossly over priced and failing system”.… Read more »

Deron S.
Guest

Jane – I will definitely check out your website. If you’re involving all stakeholders, then you’re already off to the right start.
There are some good reform efforts underway. I would like to see some consolidation of the efforts, so that the duplication of resources is reduced. My goal is to contact reform leaders and try to bring people together. I have a feeling that the Mayo Clinic effort will be high on that list.

Jane Jacobs
Guest

Deron: Thanks for opening up a great discussion. I wanted to respond, in particular, to Peter’s post regarding convening stakeholders to come up with solutions. In the interest of full disclosure, I work for the Mayo Clinic Health Policy Center (HPC). Over the past two years, the HPC has gathered more than 2,000 leaders in health care including patients and patient advocates, health care providers, insurers, large and small employers, government representatives, member of academia and representatives from medical and pharmaceutical industry. The goal was to reach consensus about priorities for patient-centered health care reform. These groups have agree to… Read more »