“In our last discussion, Julie, we presented some ideas of
ways by which health care delivery in the U.S. might be changed.”
“As is customary with us, Curmudge, the ideas were not
original. So shall we continue to
share the words of wisdom of others?”
“Of course, but we must keep in mind the two schools of
thought on the subject. Some
people believe that excellent health care should be provided to everyone; others believe that excellent health care
should be available to everyone. You and I belong to the second
school. We also feel that
patients—with their physicians—should be free to make their own health care
decisions, and that they can do it best if they have some ‘skin in the
game.’ Recall that in our last
discussion the last two examples reflected the second school of thought.”
“There are a lot more good ideas to be shared, Curmudge, but
space is limited in our blog. A
really profound document to recommend is the Economic
Outlook from Premier Inc. healthcare alliance. Let’s share some of the high points presented in the Outlook
by Harold D. Miller in his paper ‘A National Strategy for More Affordable
Healthcare.’ Here are some
of his observations:
‘Costs may be reduced by improving
disease prevention; diagnosing and treating serious conditions at an earlier
stage; avoiding unnecessary and potentially harmful tests, interventions,
and medications; eliminating dangerous and expensive infections and medication errors;
and educating chronically ill patients on how to manage their conditions to prevent
costly hospitalizations.’
‘The country is
too diverse for a single national solution.’
‘Providers and
payors must remove the veil of secrecy that has shrouded cost, quality, and
price information.’
‘The proposed “incentives” are just a new
flavor of pay-for-performance based on the same fundamentally flawed
fee-for-service system. Two basic
payment reform systems are episode-of-care payment (a single payment for all of
the services associated with a single acute episode) and comprehensive care payment
(a single risk-adjusted payment to cover all of the services a patient needs
for a particular condition or set of conditions over a period of time). These changes can only be accomplished
in mutually accommodating ways involving providers and payors.’
‘We can control
health care costs without rationing but only if we do it at the community
level.’ “
“One should read
the whole paper. Getting closer
to home, in his new book John Toussaint advocates designing care around the
patient and not at the convenience of the physician, hospital, or nurse. He also proposed payment for outcomes
(as in keeping people healthy), and providing transparency of treatment quality
and cost via the Wisconsin Collaborative for Healthcare Quality.”
“Even closer to
home is at home, Curmudge. Affinity Health System has been
practicing Lean for over five years and is making progress in improving
efficiency and patient safety and reducing waste. One can develop a Lean culture locally irrespective of what
is occurring at the national level.
So Old Guy, after all of our reading and writing about health care here
and elsewhere, what do you foresee occurring in health care in the U.S.?”
“Foresee! Do you expect me to have a crystal ball
in my briefcase? However, it’s
clear that there is no shortage of good ideas about improving our flawed health
care system. What we need are a
few philosopher kings to purge their parochial mindsets and reason together.”
Kaizen Curmudgeon
P. S.—An Alternate View
“What’s this P. S.
stuff, Curmudge? What’s up?”
“Well, Julie, no
sooner had I typed the last word above when I found something interesting in
John Goodman’s latest
blog posting. It is an article
in the New England Journal of Medicine titled ‘A Systemic Approach
to Health Care Spending.’ I
recognized the authors as big guns in ‘big-government’ medicine. Out of fairness, I felt that I should
mention it.”
“I am amazed by the kindness of an opinionated old
codger. So what was in the
article?”
“According to Goodman’s summary, the two most important
proposals are: (1) market-wide negotiation leading to all-payer fees (every
third party pays the same) and (2) a ‘global budget’ cap on the rate at which
these fees can increase over time.
I suspect that these signify more stringent regulations for providers
and payors. Goodman says, ‘the proposal virtually guarantees that no
provider is going to experiment, innovate, and try to find alternative ways of
lowering costs, raising quality, and improving access to care.’ “
“And what do you
say, Ancient Oracle?”
“Despite these
guys’ prominence and power, I characterize them as faux philosopher kings.”
“And what might
become of all this?”
“I shudder.”
K. C.
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