Thursday, December 11, 2008

A letter to the President Elect

The President Elect is welcoming comments from the public via his website at I'm sure he and his transitional team have had plenty of ideas, hopefully constructive and helpful, since his historical win.

When it comes to healthcare, I personally believe that the public doesn't want to do all the research in uncovering the best doctors, hospitals, or health insurance plans anymore than they want to research the most financially solvent bank or safest restaurant to eat in. Nevertheless I wrote my book Stay Healthy, Live Longer, Spend Wisely - Making Intelligent Choices in America's Healthcare System precisely because that is how the healthcare industry and employers, who purchase the insurance, feel that the system as a whole will improve. At least if that is the expectation, provide the public the skills and knowledge to make the right decision.

My comments to the President Elect highlight a very different system of reform, which already exists and is a uniquely American solution to the healthcare crisis.

To President Elect Obama:

Healthcare is currently provided by hospitals and doctors each working separately in little fiefdoms which worked well two centuries ago when patients died of acute illnesses and infections. Today patients are busier than ever, caring for aging parents, and dealing with chronic illnesses, that were never faced by generations ago. The public already gets a variety of choices in financial services, consumer electronics, air transportation, and dining, which are often provided by well-run, highly regarded, focused organizations. Why not healthcare? Americans don’t want the level of responsibility of researching doctors, hospitals, or health plans anymore than they wish to review the safety records of airlines, DUI reports of pilots, or the maintenance records or airworthiness of the aircraft they are about to get on. Similarly with healthcare what they expect and want is a patient friendly healthcare system to care for them when they get ill.

The good news is that a uniquely American solution already exists and can deliver on this promise. Research has shown that the vertically integrated healthcare organization Kaiser Permanente consistently outperformed university and community hospitals in decreasing risk of heart disease by 30 percent. Other studies have shown that the VA healthcare system with its salaried doctors provided better care to its diabetics than doctors in the fee for service community. Other organized healthcare organizations like Geisinger Health Plan and Harvard Pilgrim Health have also shown superior outcomes than the fragmented uncoordinated doctors and hospitals around them.

Healthcare will never be cheap, but we can get more for our dollars. The Dartmouth Atlas of Care found that even though there was not a large difference in health outcomes, the cost of caring for Medicare recipients in the last two years of life varied widely from $93,000 per patient at UCLA, $85,000 at John Hopkins, and $78,000 at Massachusetts General, to the lowest at $53,000 at Mayo Clinic. The "savings" from the most expensive programs could be moved to provide better access or quality care to those who need it, but it won't change the total medical cost expenditures.

Our healthcare crisis will only be solved if the entire industry reorganizes into systems which are aligned to focus on the end product, great healthcare delivery, rather than the piecemeal mom and pop cottage industry which currently exist. This is far harder than it sounds and will require leadership from within healthcare to get it done as well as federal leadership on changing the payment structure to encourage quality rather than volume.

If as a country we fail to solve this crisis, our economy will simply worsen as the workforce will become increasingly unhealthy as more people find healthcare unaffordable and consequently will be unable to work or be competitive in a global marketplace. This is a competition we cannot afford to lose.

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