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A Bill of Rights for Health Care Reform

Our nation’s Founders created a pretty good system of government by starting from what they wanted to achieve, exemplified by the Bill of Rights, so perhaps we would be wise to base health care reform on a similar footing.  Instead, Congress is doing its usual muddled process to produce legislation that is likely to make no one very happy, but at least tries to minimize the number of people made very unhappy.  As is too often the case, it is easier to create straw men to attack than to address the real problems. Insurance companies seem to be everyone’s favorite target to demonize, but the “evil” health insurance industry is like the various other players in the health care system: responding to the numerous and often perverse incentives in the current system.  There are bad things done to people by insurance companies — as there are done by doctors, hospitals, government, and just about every other player in the health care system.  There are both angels and demons working in health care, but mostly it is just normal people.  Perhaps ninety-nine percent of the people working in the health care system try to do right by the people they serve, but “doing right” may not mean the same thing to different people.

The problem with our health care system is that health care has become something done to patients, something too complicated or too important to let those patients take responsibility for — the way they manage the rest of their lives.  “Patient” may indeed be an appropriate description, since they certainly need plenty of patience with the various ordeals they face navigating the health care system.  We need a better word, and since “consumer” has somehow been tainted by its use in “consumer driven health care,” perhaps we should just talk about people as people. So let’s start from first principles and imagine the things we want to be true in a reformed health care system:

1. Everyone should be able to obtain meaningful health coverage, in a risk pool that spreads risk across a broad spectrum of risks.  Even – and perhaps especially — people with health conditions must be able to get health coverage that doesn’t discriminate against them for having those conditions.

2. Insurance companies have a right to be able to maintain a broad spectrum of health risks. People with health conditions can’t be allowed to get health coverage only when they need it; not even Medicare accepts anyone at any time, at least not without penalty.

3. People have a right to affordable – but not free — health coverage and health care.  There should be public subsidies to help lower-income people pay for health coverage and health expenses not paid by their health coverage, but everyone should have direct incentives to spend money wisely, as if it was their own money…which, in a very real sense, it is.

4. People have a right to use their health care data to manage their health.  Providers need to keep their own records (hopefully electronically), but the information belongs to the patient, and should be collected in a way that is easily available, portable, comprehensive and actionable for each person, across time and health care providers.

5. People have a right to make informed choices. There need to actual choices — of treatments, providers, and health plans – and for each such choice there need to be solid data about costs, quality, and effectiveness that consumers can use.

6. People have a right to be able to understand their health coverage, and fairly compare their choices. Insurance policies are too filled with legalese and confusing exclusions/limitations (the “fine print”) that vary between policies and companies, making them very difficult to understand or reasonably compare.

7. People have a right to have health care professionals who are appropriately trained and monitored. Integrated delivery systems like Kaiser or the Mayo Clinic may not happen everywhere, at least not in the short term, but well designed data reporting and analysis with feedback loops can go a long way towards achieving the same kind of peer collaboration, peer review, and use of best practices.

8. People have a right to expect that payment for health services rewards health care professionals for acting in their best overall health interests.  Fee-for-service payment on a piecework basis is a prescription for disaster, which is a fair assessment of our health care crisis – for both cost and quality.

9. Health care professionals and insurance companies that act within accepted best practices about clinical issues have a right to not be second guessed by the judicial system or other non-clinical entities. Mistakes happen, not every treatment works every time, and experimental treatments belong in clinical trials.  Punishment should be reserved for knowing or willful wrongdoers.

10. We all have a right to expect that people take responsibility for their own health.  The health care and health insurance systems shouldn’t have to artificially prop up people who refuse to try to adapt and to maintain healthy behaviors. Let’s throw in one more as a bonus:  All parties in the system have a right not to be bankrupted by truly catastrophic expenses.  Individuals, families, employers, insurance companies, and even health providers face the specter of financial ruin when a terrible misfortune falls upon some unfortunate person.  These are the kinds of events that should be a shared societal obligation. With rights come corresponding responsibilities.  We all should be more prudent about our health and how we use the health system, given the right information and with the right incentives.  The above rights would go a long way towards allowing that. None of these rights are likely to be easily realized, and reasonable people may disagree about the best way to achieve them.  In truth, there are no perfect solutions, but if we get health care reform that doesn’t address these basic goals, then one has to wonder if we will have squandered a once-in-a-generation opportunity for true health care reform.  As citizens, we can at least try to agree on the goals, and measure how well our elected officials do in meeting those goals.

Kim Bellard is former vice-president of eMarketing & Customer Relation Management for Highmark, Inc. in Pittsburgh.

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revolutiondaniel lanecurious108DAYSAG, M.D., J.D. Recent comment authors
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revolution
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revolution

to get straight to the point all heath care and insurance providing companies need to be combined into one “monopoly”, if you will. the reason that there are so many problems with insuring the people and having affordable insurance is that the competitive market focuses on making money, the only way they can do that is by raising rates, then another will lower theirs slightly to make it seem that some good is being done. but as with all of them if you can understand all the legal and technical bs you find that its really all the same. if… Read more »

daniel lane
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daniel lane

The doctors are making to much money!!! Ok education and hard work yes i understand that . But have any of yall paid for medicine lately ? O yall are jus the advil users bottom line this healthcare is gettin out of control . its time to correct this matter Go OBAMA!

108DAYS
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The entire industry needs “monitoring.” Take a look at this website http://www.deadbymistake.com

curious
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curious

Just curious – why do you feel doctors need to be “monitored?” They are already well-educated and well-trained. Why not let them do their jobs? Costs would plummet without the regulatory nonsense.

108DAYS
Guest

I’m with Mike

AG, M.D., J.D.
Guest

There are bad things done by the beneficiaries who receive the healthcare benefit. Yes the patient is to blame. MEDICARE AND MEDICAID BENEFICIARY ABUSE: IS THE BENEFICIARY TO BLAME? The Center for Medicare and Medicaid (“CMS”) lays the ground work for providers and physicians committing fraud and abuse within the Medicare and Medicaid system. Provider and physician fraud accounts for between 60 to 100 billion dollars per year. However, CMS makes no provisions for abuse committed by the beneficiary. Yes, the recipient of emergent or urgent medical care may be guilty of abusing the healthcare system thereby costing the government… Read more »

creatine
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I like the principles given in the Article. I am learned a lot from this article. I liked the 6 and 9 principle.

Mike
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Mike

Kim, If by structural you meant the capacity of health insurers to operate at loss ratios of 80%, and the capacity of the profit based health insurance industry to bend the ear of Congress to insure its continued existence, then yes, by all means, the problems of health reform are structural. And as Klepper et all point out cost incentives are perverse. However “rights” are not the way to address that problem. Klepper et al are making that general point themselves when the conclude: “Finally, the American people should demand that Congress revisit and revise the conflicted lobbying practices that… Read more »

Kim
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Kim

Mike – at the risk of prolonging a discussion with an anonymous poster about something that appears to be more of an article of uncompromising faith for you instead of something that can rationally be discussed, I honestly have a hard time understanding the animosity towards insurance companies. I don’t expect the federal government to pay for my groceries, my housing, or my/my kids’ education, so I don’t quite follow the arguments about why it should be true for health care. Even Medicare, the model that many single payor advocates would build on, is deeply flawed — antiquated design, only… Read more »

Mike
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Mike

Kim, What the hell is a “bill of rights for health care reform”? Who or what is health care reform that it needs “rights”? Last time I checked a Bill of Rights grants someone, you know, “rights”. I’m pretty sure that “health care reform” isn’t a person or entity in need of rights. Your scheme makes that quite clear that “health care reform” is some new rearrangement of a health insurance industry based health care delivery system. What you have written is more like the slavery accommodating American Constitution. I’m not without understanding for your position, much as I can… Read more »

Eric Dishman, Intel Digital Health Group
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The responsibility that each and every one of us has as a consumer of healthcare services is an important piece of the health reform puzzle. We as patients—as consumers of healthcare services—have to behave better and differently if we are to achieve healthcare reform that covers everyone, improves quality, and holds costs and the deficit at bay. This means being more informed about the costs of the healthcare services we are using, engaging in preventive healthy activities, and being proactive about managing our health.

Kim
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Kim

To Dennis: yes, certainly people who are truly incapable of making decisions on their own behalf need different treatment, with someone making decisions on their behalf, and certainly health care often puts even the most intelligent & decisive individuals at a loss as to the “right” decision. But what I don’t think we can afford is a system that treats all patients as incapable and blindly assigns the decisions to the health care professionals. We need to orient towards people being responsible, and look for ways to give them the best information, and to give the various entities the right… Read more »

Dennis
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Dennis

I think your bill of rights covers a great deal that we need, but you don’t address one often forgotten issue: there are many people in this country who simply cannot — through no fault of their own — be the “responsible” patients your bill assumes. (I’m mainly address points 4,5,6, and 10.) I’m refering to the elderly suffering from dementia, the mentally ill, and, in some cases, the typical person when confronted with an unknown or incomprehensible ailment — that may or may not be serious. And while, viewed from the perspective of the nation as a whole, we… Read more »

Mike
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Mike

Who can resist a rewrite of the Bill of Rights before dinner? Not me! But this bit of insurance industry hackery misses a basic point about the Bill of Rights, to wit, that it is a bill of largely individual rights. The absurdity of a Bill of Rights that grants some of those rights to the insurance industry should not need stating, but in case it does, here goes. Skip to the end if you want to read the summary. “1. Everyone should be able to obtain meaningful health coverage, in a risk pool that spreads risk across a broad… Read more »