10 Random Opinions on Health Care Reform

I was asked to participate last week on a Health Care Reform panel for Leadership Rochester. While I said yes, I couldn't help but wonder what qualified me to speak on behalf of health care reform. Like everyone else, I haven't read the volume of text on the subject and don't know anything more about it than the next guy. But there I was sitting up front at the panelist table between two VPs from Excellus Blue Cross and MVP.

We hadn't rehearsed our individual talking points, but as we were called upon by our moderator, Fran Weisberg Executive Director of the Finger Lakes Health Systems Agency, we each shared some insights and opinions. Surprisingly, we covered a lot of ground and presented a very comprehensive and informative perspective on the complicated and controversial subject matter.

I guess 30 years in the health care business qualifies me to serve on a panel of "experts" and to even have an opinion or two on the subject. So if you're interested, here are 10 random opinions on health care reform:

1. The U.S.A. spends too much on health care and isn't getting its moneys worth. We spend 16% of gross national product on health care (more than any other country) while the rest of the developed countries range between 7-10%. Our health care cost per capita is nearly double the average of all other developed countries. While we are a leader in cancer treatment, we have a high rate of deaths from preventable/treatable conditions and a far higher prevalence of heart disease, stroke and cancer in individuals over 50 years of age.


2. The cost of health care is growing faster than it should. Our annual rate of growth from 1980-2007 is higher than any other nation at 7%, compared to the average of 2.3%. 27% of this increase is general inflation, 30% is health care cost in excess of inflation and 43% is increased utilization. The average cost for a single and family health insurance policy has increased 131% in the past 10 years and now averages $4824 and $13,375 respectively.


3. There's too much waste, inefficiency and fraud in our health care expenditures. In 2007, we spent 2.3 trillion on health care and it is estimated that more than 800 billion is waste and inefficiency. For the record, only 11 cents of every insurance premium dollar goes to administrative costs.


4. Health care reform needs to prioritize managed care. Efficient utilization and health care management are key to controlling costs and maximizing benefits. Understanding and navigating the complexities of proper health care management is not easy for most individuals. Professional case management and uniform clinical pathways will lead to better utilization and outcomes.


5. Health care reform needs to be "person-centered and person-directed". We won't stand for any reform that feels like it is being dictated to us or is simply financially or politically motivated. Today's consumers are more demanding, more informed and more involved. We want options, choices and "one size doesn't fit all".


6. Individual consumers need to have "skin in the game" to ensure proper choices. If health care is free to all and of equal quality across the board, there is no incentive to make wise consumer choices with respect to utilization and cost. Reform needs to include consumer co-pays, deductibles and incentives to drive good choices.


7. Health Care reform should include basic coverage only. We can't ignore anyone in need who shows up outside our health facility doors, but our focus should be on basic health care coverage. Like food, shelter and clothing, we need to protect every one's basic health care needs. Beyond that, every individual can choose to work towards whatever level of enhanced or luxury health care they desire and can afford.


8. Reform should include the option for dignified and individual-directed death. We are living longer and healthier. Health care technology and advancements provide us with many life-extending options. But when should we accept the inevitable end of life? We spend an exorbitant amount of health care dollars within the last year of one's life and more specifically in the last 100 days. Advanced directives and dignity in dying should be embraced. Reform should include an individual choice to receive more preventative/maintenance health care coverage in lieu of acute and chronic care coverage later in one's life.


9. Reform should include "bundled rates". We currently have a silo-system of health care providers. Hospitals, nursing homes, physicians, home-care, out-patient clinics all providing services independently and being paid on an individual fee-for-service basis. This creates fragmented care, duplication, inefficiencies, confusion and higher costs. In a bundled rate system, one controlling entity would be paid a lump sum for any individual spell-of-illness and be responsible for the care-management of that individual throughout the spell-of-illness. This would require joint-venture cooperation and collaboration among all providers and promote incentives for cost containment, balanced with quality standards.


10. Keep it Simple Stupid! Yes, this is complicated stuff and the devil is always in the details, but twice we have failed to pass any meaningful health care reform because we have simply made it so complex with volumes of regulations that nobody can understand it or trust it. Like the old joke says, "How do you eat an elephant?.............One bite at a time." If we follow some basic premises and move slowly, one step at a time, perhaps we can enact some real health care reform in the future.

My opinions only. Thanks for visiting my Blog and here are some fun pictures you may enjoy!

Here I am tending bar again, this time as a guest bartender at the Kirkhaven Friday afternoon Happy-Hour.

Now that my wife is retired and between jobs, she is busy cooking me meals and baking sweet desserts (how many calories are in that thing anyway?)

Eating grandpa's pasta for lunch (out of camera's view is my dog Jessi sitting nearby and eating every ziti that Logan managed to drop).