Wednesday, July 22, 2009

Point/Counterpoint: Health Reform

Health reform is the big issue on the congressional agenda this month. With that in mind, we'd like to know:
What five components do you think would be necessary for health reform to be truly successful?
Join us in the discussion section as we debate the issue.


  1. Only 5 things? That makes for a challenge. It’s important to first outline what it is that we mean by success. There are many people who believe that health care reform succeeds only when it maximizes coverage whereas other believe that success will be determined by reforms ability to protect and promote a competitive market for insurers. For me, the success of health care reform will depend on its ability to produce efficient economic and health outcomes.

    1. Some measure of public plan that guarantees coverage. Unless, you have a means for forcing insurance companies to compete for coverage of all individuals, we will still be faced with the problems associated with pre-existing condition denials and massive litigation to limit insurance pay outs
    2. A comparative effectiveness program that is based around data production and not enforcement. I think that the data that can be drawn from a good CER program can be invaluable to doctors and patients, provided it is used for information, but giving any sort of policy weight to CER has the potential to create a means of dictating care.
    3. A significant increase in public investment in research. Given the costs of a public plan, we would be wise to invest in research in order to drive the sort of preventative care an innovation that can turn sick care into something resembling health care.
    4. Making health insurance mandatory. My controversial choice. If we make health care available to everyone, it becomes a massive inefficiency to have people who still don’t have it. This externality places an increased burden on those responsible enough to have health care. I realize there are concerns about government dictation of behavior, but if require car insurance, I think it’s ok to require health insurance. Yes, there are 2(!) states that don’t require auto-insurance (NH and WI), but both of those states require that you have sufficient assets to pay any claim.
    5. A significant upgrade in Health IT and electronic medical records. This is another place where a technological upgrade can improve health outcomes in order to limit future costs to consumers.

    So this ran on a little long, but there are my five things.

  2. I agree with Takao on points 2) comparative effectiveness research, 3) investment in research, and 5) upgrade in infrastructure. The debate needs to move beyond health INSURANCE reform to include health CARE reform. These points will help move towards improving the effectiveness and quality of the health care system. My ideal goal—move beyond the chronic care system we have now where we treat disease and instead work to cure disease. However, it is hard to legislate that. Point 3--investment in research--plays into curing disease.

    So I have these as my first three points:
    1) Comparative effectiveness research
    2) Investment in research
    3) Upgrade in infrastructure

    I’d add the following points:

    4) Reimbursement reform: CER is great, but it needs to have teeth if it is truly going to reduce costs. People will make the argument that CER is a means of the government telling patients what care they can and cannot receive. This shouldn’t be the model. CER shouldn’t restrict care from being administered; it should restrict reimbursement of care that isn’t in the best interest of the patient. Restricting care and restricting reimbursement are different arguments.
    5) Affordable health insurance options: While I don’t oppose the concept of a public plan, I don’t think it’s the only viable option for affordable health insurance. Co-ops, workplace solutions, and community-based plans are also options. I agree that the public plan has the potential to be one of many affordable health insurance options.
    6) Incentive to carry health insurance: There needs to be an incentive to have insurance regardless of how you acquire it. It is too expensive for people to rely on the free ER treatment. However, I'm not as comfortable with a federal mandate for insurance.

  3. As Takao said, I believe that the success of health reform depends on the ability of the system to produce efficient economic and health reforms. The changes must not only result in improvements in care, but must also be sustainable. As far as specific components are concerned…

    I am in agreement with Matt and Takao on:
    1) Comparative Effectiveness Research: CER will help reduce costs, assist with clinical decision-making, and improve patient care.
    2) Investment in research: necessary to ensure continued progress and innovation.
    3) An upgrade in infrastructure: this is crucial for the future.

    And my other two points:
    4) Affordable health insurance options: health coverage for all is essential and I am not opposed to a public option. But like Matt, I don't think it is the only option. And I think a strong private market is important.
    5) An increased focus on wellness and prevention: this is actually one of my most significant concerns. Although Takao mentioned it under investment, I think it is actually a crucial component on its own. One’s lifelong health can be significantly improved (and many problems can be avoided) by focusing on prevention and maintaining a healthy lifestyle. And this will save a ton of money.

  4. The problem with the health reform discussion right now, is that it is focused on insuring people and therefore assuring their care. But, we know that just having insurance is not the same thing as having good health. In fact, they don't always correlate. What if, instead, we just tried to improve care and got rid of the insurance model?

    Health reform should be about making our country healthier at a more affordable cost.

    1. Health IT. I should be able to access my health records at any time and bring them with me to the doctor of my choice. Also, this saves trees and others from the horror known as "doctor's handwriting."
    Cost savings: less documentation supplies and records storage, fewer repeat tests and wrong treatments.

    2. Incentivize primary care for physicians. People would be healthier if they could get in to see their doctor - heck, if they could claim to HAVE a doctor. Right now, specialists get the best pay and have the least reach. If we can increase the number of primary care physicians, we can help people find the care they need at a more basic level.
    Cost savings: less visits to inappropriate specialists, more preventative treatment, faster treatment of existing conditions, less emergency room or free clinic visits.

    3. Research. Figure out the best way to provide care without having to try five or ten different ways first. Saves time, saves money, saves the agony of whatever is ailing you. Personalized medicine is the way to go.
    Cost savings: Investment in research to improve health has a 2:1 return in the long term.

    4. Increase prevention and wellness. Start with putting required PE back in schools. Put taxes on the things that are most harmful - like hyper-sugary/fatty foods. Have restaurants display calorie counts. Build sidewalks and bike lanes. Invest in public health departments and city sports programs. Etc.
    Cost savings: less bad health to begin with, improved neighborhoods and higher community involvement.

    5. Invest in state-level health improvement. Every region has it's own special health concerns - instead of sweeping the nation with a single health reform, let the states fund programs that will target health problems that effect them specifically like cardiovascular disease, skin cancer, infant mortality, or geriatric care.
    Cost savings: puts the needed treatment in the right places, instead of the general treatment everywhere.

    If we're going to sink money into health reform it might as well improve health.

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