Better Health Care for All - There is a Way

Enjoyed your commentary in the 8/27 WSJ.

If we assume universal health care is a right, then we have to also assume that in a democratic society citizens get to vote(approve) that entitlement.
By voting approval, they implicitly approve the cost of so entitling.

People resist the cost of platinum-level health care, with all the devices and pharmacological magic bullets that implies, unless it is their need that is to be met.
But, they have no ability to shop for care-compare prices- because there is no mechanism for doing so. Further, unlike branded merchandise where you can get performance information and ratings from Good Housekeeping and others, such information is not readily available about health care and providers due to the insular nature of the profession and it's various so-called "practice oversight societies."

If one were to take a group of aliens into a conference room and ask them to design a logical, pragmatic system of health care, our current system might not even wind up on the "top ten" list.

As I see it, Cost and mechanics of delivery-the process, the system, are both ill-suited for today's world.

First, the delivery system, since that has much to do with the cost.

When I was in business, I always told my executives that it was important to prioritize their personal resources in order to be effective, "Don't pay a hundred- dollar-an-hour executive to do a ten dollar an hour job."
By this I mean that, in connection to health care, we throw the greatest amount of talent, the doctor, right at the front lines-the initial contact- when trained Nurses and LPN's could do a highly effective job of initial diagnosis, subject to review by a doctor as necessary. Pretty rapidly we would find that 90%+ of intakes could be managed without a "hands on" by an attending and in a different location and setting.
(Even better, computerized diagnosis would streamline the process, deliver information quicker to a professional, and increase care quality by increasing diagnostic accuracy).

The place of initial contact also has much to do with cost. Even now, neighborhood local clinics, some staffed by doctors, others being tried with LPN's, are coming. This experiment starts the process of matching the level of care needed with the type of delivery. You don't need a high cost hospital emergency room for a pediatric ear ache, or a finger cut requiring a few stitches. Care by a fully-accredited professional should be reserved "up the line" for cases requiring a higher level of care. Combine changes with the delivery system with new methods of high-volume initial diagnosis through computerized processes and you may be able to "reinvent the wheel" of medical care, which in my opinion currently evidences a buggy whip mentality in terms of delivery of service.

Now to cost.
Changing the method of delivery greatly impacts the cost portion of the equation.
There should be catastrophic coverage for everyone as needed, but much smaller premiums for day-to-day coverage, or even, no day-to-day coverage at all, since my estimates put the cost of annual checkups and shots as needed, well person care, at substantially less than the premium cost of providing insurance coverage. However, the idea of assessing some premium for everyday coverage is appealing because, at a modest level, many Americans would be willing to help cover those unable to obtain coverage or be insured. There is the sticking point of whom pays for coverage for illegals, and for those whose lifestyles lead to medical problems- drugs, alcohol, smoking.

Most Americans who know that their insurance costs help cover the cost of the uninsured get apoplectic when asked about the fairness of paying for illegals and others, but a new system might offset these feelings. Using "tiered" delivery leads to tiered reimbursements and cost allocation. A local walk-in clinic might get a $100.00 payment for the ear ache or finger cut visit, compared to the $400.00 plus ER cost that most hospitals charge.

Why write you about this?

Your column seemed to indicate a thinking process that is more progressive that others, maybe more attuned to the idea of significant changes. If so, then I would ask that your Institute consider funding the development of a trail program to apply these principles to care practice.

1. Tiered delivery of care. Local clinical set up to a GP/Interest diagnostic practice, to hospital-based process.

2. Computerized diagnostic intake process for annual physical exams and emergency care.

The cost would be extensive, the positive result, however, would lead to savings of hundreds of billions a year, far exceeding the cost of universal coverage. I might point out that though there are 40-50 million uninsured, hardly anyone goes without medical care somewhere in the system, usually at the most expensive level.
It might be necessary to partner with other foundations to underwrite this project, but if you agree that it offers real value, then I hope your will respond positively.

I can provide additional background and concept information if needed, but this is the basic idea.