September 1, 2007

Health Care Vision

Last week, I appeared at the National Press Club an event sponsored by the Century Foundation, the AARP, and theCommonwealth Fund to discuss health care reform.

In preparing for that event, I came to realize that my vision of a national health policy has undergone refinement since I started my blog a few months ago. So here it is, although in abbreviated form:

  • Any national health policy has to be based on the goal of maximizing health, safety, well-being, and productive capacity of all Americans.
  • These goals, if achieved properly, will improve economic growth and competitiveness. They will not drain our economy, and we will not need to ration care to achieve them.

To achieve these goals, our health system will have to be based on six principles, all of which need to be followed:

  • Health care plans need to incent healthy behaviors, and disincent unhealthy ones, and to reward high quality care and penalize low quality care.
  • Americans need convenient access to the right providers, the right technologies and processes for health monitor and improvement, and the right information. Convenient access includes 7×24 access to the right providers and reasonable waiting times for care.
  • The health care system needs to be of high quality and needs the capacity and the processes for continuous improvement, consistent with Six Sigma principles.
  • The best quality will be achieved only if there is meaningful competition for providers at the level of primary and specialist care for specific medical conditions, including complementary and alternative medicine.

What are some of the implications of these principles?

  • Employer-based systems like ours at Pitney Bowes should remain an essential component of the health care system, even if the rest of the system is reformed. Government-managed systems will generally fail to achieve these goals because decisions will get made on political grounds and will use slow-moving, bureaucratic processes to insulate them from criticism by voters.
  • If we focus primarily on coverage, as many politicians have, we will be “rearranging the deck chairs on the Titanic,” and just reassigning burdens of a currently dysfunctional system.
  • Plan providers and payers need to understand the behavioral consequences of plan designs, such as the likelihood that higher prescription drug costs for chronic diseases will result in non-adherence to treatment plans by patients and much higher future costs.
  • Healthy behaviors are discouraged by such government actions as excessive subsidies for commodities that are integral to low price per calorie of less healthy “junk” foods like snacks and soft drinks, and inadequate subsidies for fruits and vegetables. Agricultural policies have a profound effect on our obesity problem.
  • The recent government regulations, which limit wellness incentives by employers, are horribly misguided.

I will have more to say about these principles later.