The best way to predict the future is to create it.
What follows is a 2 page attempt to solve the Health Care and Health Care Financing Crisis. Before you dismiss the style and substance of this report, let me suggest that it is not complete but it is understandable. It is short so the American people can read it. It is apolitical so maybe it is motivated by what's best for patients that use care and tax and premium payers that fund it. Finally I'll suggest without a hint of humility that this has a substantially greater chance of working than does the current document being written in our Capitol. I'd encourage you to refine as neeeded. Remember you can add 998 pages and still be shorter and more understandable than the "work in progress" being prepared by professionals... Be well!
One day as the centipede limped along, he noticed an owl carefully observing his progress. “My feet hurt” yelled the centipede. “You’re wise Mr. Owl can you offer me any help?” “Certainly” said the owl. “Simply walk with your feet about 1 inch above the ground.” The centipede responded, “Great idea but how do I do that?” The owl answered, “I don’t know; I only deal in concept.”
Inspired by the wisdom of the owl, I’ll now offer the solution to the Health Care (HC) and Health Care Financing (HCF) Crisis and the Health Care Reform Process - “remove the politics.” Before you ask - let me remind you that like the owl - “I only deal in concept but I assure you it will work.”
Here’s the good news - we currently have the best HC system in the world. The bad news is that it is unaffordable to many, unsustainable as a system, and not accessible to millions. To bracket the bad news in good news - let me offer one more positive observation. We currently have enough money in the systems (HC / HCF) to pay for care or coverage for every man, woman, and child in our country. Our problem is not dollars - it’s the dysfunction in our processes - manifested as waste, irresponsibility, duplication, friction, fraud, inefficiency and lack of efficacy.
To prove this point - I’ll throw out these numbers without verification and trust that if a skeptic or an economist tries to discredit me they will find I’m right. Today in America we spend over $7,500.00 annually for every man woman and child for their care - from womb to tomb.
With universal coverage (versus universal care) our costs would be no more than $5,500 per capita and that’s before savings from consolidation of systems and the efficiency that follows, leveraging technology, enhanced focus on wellness / preventive care, effective regulation, and cost-shifting (15 - 20 % of insurance premiums are from Medicare / Medicaid under funding and uncompensated care).
If we have the Political will to also require institutional and personal responsibility and choices accompanied by consequences (in lieu of the “victimhood” mentality and entitlements that exist today) - the additional savings will be enormous.
To prove my numbers I offer the following - a family of four in a large group can be insured with “Cadillac” coverage for well under $16,000.00 annually. Thus $4,000.00 per person is an aggressive allowance. In a similar large group - Long Term Care (LTC or care in the long term - home care, assisted living, and nursing home coverage) would be less than $1,500.00 annually. Add these together and you get the $5,500.00 number presented.
Now I urge each of you who are enthused to see this concept develop in concrete terms - work diligently to get the politics out of the reform process. To incent each of you in your efforts - I’ll offer the following concrete ideas on what might work.
If we want to respect the “democratic” history of our country - I’ll merely suggest a process for reform. To begin the process establish the Mission of providing excellence in care or coverage to every man, woman, and child in this country that is readily accessible and affordable and sustainable to us as a system.
(Before you “poo-poo” this ideas as undoable - remember we’ve already walked on the moon. Also understand that when JFK proposed that goal [May 25, 1961] the science did not exist to do what he proposed. It was impossible.)
Once the Mission is established select a design and implementation team of no more than 20 people - the best and brightest from each of the major stakeholders in the current systems. This would include representatives from consumers (patients, taxpayers, premium payers [individuals and business owners]), providers (physicians [MDs, NDs, ODs], home health agencies, hospitals, etc.) regulators, insurance companies (including brokers, Third Party Administrators, etc.), pharmaceutical companies, the media, the legal community, etc.
Once the group is assembled - have them identify their existing “special interest” (MD, hospital administrator, etc.) and thank and honor them for their knowledge and expertise and passion from the past and charge them with a new “special interest” for the future. In other words the designee from Hospitals might be charged with representing the interest of pharmaceutical companies, pharmaceutical companies might represent the legal community, and the legal community may be responsible for the needs of physicians. Get the picture?
This would be the ultimate “reality” show - Survival. If you do not focus all of your energies on the Mission and an enthusiastic and effective representation of your “newly assigned” special interest you’ll be voted off the reform panel (Island).
Place parameters on the process - a universal budget (number of dollars per capita for care or coverage), the number of days for the process to be completed, and access to researchers to determine reality so that this process is built on fact not anecdote. Then let them get to work - get out of their way.
If at the halfway point in the process results aren’t developing - lengthen the work days, if progress doesn’t improved turn off the heat or cooling, if progress remains limited - move the event outside. Discomfort is a better motivator than is comfort.
If the democratic process does not appeal to you I can be named King. With unlimited power - I’d create a base of actionable knowledge and standards based regulation. The government would fund the needed “information” superhighway to connect all players. All citizens would access coverage through private plans in a Federal Employee Benefits model - the government would pay for Medicare and Medicaid beneficiaries. Regulation would be virtual, transaction monitored, and adjudicated by exception. The private sector would then compete with great rewards or severe consequences. This plan has only 2 pages and is understandable.
Copyright - Michael G. Manes (July 29, 2009)
All rights reserved