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True Health Reform
The U.S. has just passed legislation on health insurance reform.
It is not a bill on health reform, nor is it focused on health sector reform.
It does open up the door for insurance companies to take positive and effective steps to “bend the cost curve” in many ways.
Early in the 20th century, New York Life did exactly that. It hired registered nurses to visit their policy holders and talk about hygiene, nutrition, smoking and habits known to shorten life. Since New York Life was an insurance company that benefitted financially from having long-lived customers, the visiting nurses put NY Life’s competitors behind the curve, and its clients in an enviable position.
Insurance companies will now compete for some 49 million uninsured Americans. Approximately 32 million of these will be required to take out insurance. The rest are estimated to be undocumented aliens or people choosing to pay a fine rather than to be insured.
The insurance industry now is offered the opportunity of a lifetime to negotiate plans that reward healthy behaviors, incentivize efficient and effective health care delivery, cover preventive medicine, and allow for integrative medicine. This is the potential of health insurance reform.
By itself, insurance only improves access to care. It does not necessarily ensure the availability of care, the appropriateness of care, the acceptability of care, the accountability of care nor, above all, the affordability of care.
But insurance could reward steps that would positively affect all of these desired objectives.
Even health insurance reform is a work in progress. Soon we may see queues, like those in Canada and Europe, resulting from increasing demand for care not matched by increasing supply. That affects availability.
Then there will be tension between those who believe in evidence-based medicine as a condition of insurance coverage in contrast with what might be called the art of medicine. I am reminded of the inscription over the entrance of the Sorbonne Medical School in Paris: “To cure, rarely; to help, sometimes; to comfort, always.” Should insurance cover “comfort?” If so, what if comfort is given by other than health care professionals? What appropriate care truly is may never be finally settled.
Then there is the acceptability of care. The kind of care that produces enough mistakes to cause at least 98,000 Americans to die each year in this nation’s hospitals is not acceptable.
Consider the accountability of care. Accountability is not about tort reform. It is about the positive philosophy of accepting responsibility for the care that is delivered, conscientious follow-up with patients, learning from mistakes, reporting mistakes, reporting all outcomes, and making health care transparent.
True health reform must focus on two key areas:
1. What makes people healthy, and
2. Acting on that knowledge.
About 20% of all causes of preventable deaths are genetic and another 20% are environmental — people still die from breathing polluted air, living in hazardous neighborhoods and living in countries where human life is considered less significant.
Seventy-five percent of health care costs in the United States derive from chronic disease, and half of these diseases can be prevented.
The health sector can prevent about ten percent of premature deaths. (The mortality rate is still 100%, but we can postpone deaths, within certain limits.)
About 50% of premature deaths (deaths before age 65), we cause ourselves. The personal choices we make about smoking, drinking, driving, eating, exercise and the way we live our lives can postpone Death’s arrival.
Now let me address the affordability of care. The root cause of this problem is the negative productivity of the health sector. If the health sector were to show the same annual improvement in productivity as the average American worker, this is what would happen:
1. We would need to hire no additional people to deliver care.
2. We would be able to treat ALL Americans with no increase in personnel.
3. Health care workers would continue to receive the same high increases every year in fees, wages and salaries they have every year for the ten last years.
4. Health care costs would decrease every year; after ten years the U.S. would, as a nation, pay 10% less (in real dollars) than what it does today.
5. If we truly address that which we know will make us healthy, Americans will be the healthiest nation on Earth.
And that, my friends, will be true and comprehensive health reform.
North Oaks, April 7, 2010
Tor Dahl & Associates Productivity Improvement Seminar
SAS Publishing has just released a new book, Radical Action for Radical Times. Follow this link
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