Health Care Reform

Health care reform is "innovation and improvement of the health care system by reappraisal, amendment of services, and removal of faults and abuses in providing and distributing health services to patients. It includes a re-alignment of health services and health insurance to maximum demographic elements (the unemployed, indigent, uninsured, elderly, inner cities, rural areas) with reference to coverage, hospitalization, pricing and cost containment, insurers' and employers' costs, pre-existing medical conditions, prescribed drugs, equipment, and services."^[1]

Proposals

President Obama's 2008 proposal

President Obama has summarized his proposal for public debate.^[2][3][4]

President Clinton's 1992 proposal

President Clinton summarized his proposal for public debate.^[2]

Other proposals

Re-structuring Health Care: The Three Layered Cake

We are now debating health care reform for the seventh time in the last 100 years. In the Truman years, when the debate once again went nowhere, advocates shifted their tactics away from comprehensive reform and toward a gradualist strategy. Which paid off when Johnson mid-wifed care for the elderly and poor. A return to comprehensive goals failed yet again in the Clinton Presidency. So the question now is will Democrats return once again to gradualism?

This is one approach to change what already exists in the US healthcare system and build upon it. Yet it entails more restructuring than what is currently being discussed.

• Layer #1: Medicare-like social financing of everyone. This option would be an all-in-the-same-boat insurance pool, at least for a basic benefit plan. Those who want higher level care can purchase supplemental insurance, just like the current “gap” insurance available for Medicare.
• Layer #2: Convert for-profit insurance companies into non-profit funds, following Germany’s Bismarckian model. The Commonwealth Fund ranked Germany #1 when compared to the five, industrialized, English-speaking countries.^[5] These companies would join already existing non-profits in designing competing plans, packaging the core benefit with other features. The companies would be able to make a profit on the non-core elements, as is the case in Switzerland. As opposed to the consumer rebellion against HMO’s in the 1990’s, consumers would accept being limited to a core package if:
  • The benefits have been negotiated as a part of a national conversation
  • No one is making a profit off such a limitation.
  • The Federal Government should limit itself to setting up a Clearinghouse/Exchange to help market forces work better. The description of competing plans should be standardized so that the consumer has the transparency to make informed decisions.
• Layer #3: Group practices of salaried doctors. The Federal Government should limit itself to:
  • Supporting group practices of salaried doctors following the successful model of the Mayo Clinic and a dozen other leading community-level medical organizations across the country.^[6] Each of these groups are currently partnered with non-profit insurance entities as described above. These groups of doctors would be responsible for defining best practices from the bottom up.
  • Facilitating communication among doctors groups on:
    • Safety and malpractice data
    • Best practices, incorporating comparative effectiveness
  • Negotiating with these groups on what comparative effectiveness studies should be done, leaving the interpretation of the findings to the groups for application from the bottom up.
  • Continuously working with these doctors groups in re-evaluating the basic benefit plan. (In contrast, the supplemental, private gap plans would be decided in negotiations between the doctor groups and their respective funds.)
  • Encourage doctors graduating from medical school to select primary care by following Germany’s lead:
    • Reimbursing the costs of medical school for primary care doctors (reducing the pressure to go into high-paying specialties).
    • Reimbursing malpractice insurance premiums
    • Contracting with an independent agency, chosen by the Federal Board,to evaluate the performance of the group practices which would be available in standardized format on the Exchange. Among the tools the evaluators could use: 1) a risk-adjusted outcomes measurement system (for example mortality rates), 2). resource utilization measures. Germany only spends half of what we spend per capita, and it’s possible that the US would save more than enough to finance universal health care.

Related Videos

In this video from BigThink, Jacob Hacker, Professor of Political Science at Yale University, discusses the downsides of the American health care system and potential for reform:

George Halvorson (Chairman & CEO, Kaiser Permanente) talks about Kaiser Permanente, an all-encompassing health care entity: payer, medical group, hospital and pharmacy, lab and equipment owner. Halvorson explains the secret to the company’s efficiencies in this BigThink video "You’ve Got Mail. It’s Your Doctor.":

References

1. ↑ Anonymous, (2009) Health care reform (English). Medical Subject Headings. U.S. National Library of Medicine.
2. ↑ ^{2.0 2.1} Obama, Barack. "Modern health care for all Americans." The New England journal of medicine 359 (2008): 1537-41 - Abstract
3. ↑ Obama, Barack. "Affordable health care for all Americans: the Obama-Biden plan." JAMA : the journal of the American Medical Association 300 (2008): 1927-8 - Abstract
4. ↑ Obama, Barack. (2009) Why We Need Health Care Reform. New York Times.
5. ↑ K. Davis, C. Schoen, S. C. Schoenbaum, M. M. Doty, A. L. Holmgren, J. L. Kriss, and K. K. Shea, Mirror, Mirror on the Wall: An International Update on the Comparative Performance of American Health Care, The Commonwealth Fund, May 2007
6. ↑ Gawande, Atul. (June 1, 2009) The Cost Conundrum; What a Texas town can teach us about health care. The New Yorker

Further reading

1. Emanuel, Ezekiel J. (2008) Healthcare, Guaranteed: A Simple, Secure Solution for America. PublicAffairs. ISBN-10: 1586486624
2. Arnold Relman. (July 2, 2009) The Health Reform We Need & Are Not Getting A review of "Healthcare, Guaranteed: A Simple, Secure Solution for America by Ezekiel J. Emanuel." New York Review of Books.