On the eve of President Obama's speech to Congress on health care I hope he and his advisors have taken time to read the article. The article eloquently highlights much of what I have come to believe over the last few years is missing from health care. It is a time to step back from the existing complex system and refocus on the health consumer and make fundamental changes to the existing system. Incremental change treating the symptoms and not the underlying disease will only solidify the current "insurance based, employment centered, administratively complex" system now in place.
There are too many great thoughts in this article to quote them all here -- so go read the full commentary.
Some of the quotes that caught my attention:
. . . Why, in other words, has this technologically advanced hospital missed out on the revolution in quality control and customer service that has swept all other consumer-facing industries in the past two generations? . . .
. . . All of the actors in health care—from doctors to insurers to pharmaceutical companies—work in a heavily regulated, massively subsidized industry full of structural distortions. They all want to serve patients well. But they also all behave rationally in response to the economic incentives those distortions create . . .
. . . Accidentally, but relentlessly, America has built a health-care system with incentives that inexorably generate terrible and perverse results. Incentives that emphasize health care over any other aspect of health and well-being. That emphasize treatment over prevention. That disguise true costs. That favor complexity, and discourage transparent competition based on price or quality. That result in a generational pyramid scheme rather than sustainable financing. And that—most important—remove consumers from our irreplaceable role as the ultimate ensurer of value . . .
. . . But health insurance is different from every other type of insurance. Health insurance is the primary payment mechanism not just for expenses that are unexpected and large, but for nearly all health-care expenses. We’ve become so used to health insurance that we don’t realize how absurd that is. We can’t imagine paying for gas with our auto-insurance policy, or for our electric bills with our homeowners insurance, but we all assume that our regular checkups and dental cleanings will be covered at least partially by insurance. Most pregnancies are planned, and deliveries are predictable many months in advance, yet they’re financed the same way we finance fixing a car after a wreck—through an insurance claim . . .
. . . My dry cleaner uses a more elaborate system to track shirts than this hospital used to track treatment . . .
. . . But my father was not the customer; Medicare was . . . Of course, one area of health-related IT has received substantial investment—billing. So much for the argument, often made, that privacy concerns or a lack of agreed-upon standards has prevented the development of clinical IT or electronic medical records; presumably, if lack of privacy or standards had hampered the digitization of health records, it also would have prevented the digitization of the accompanying bills . . . In case you wonder who a care provider’s real customer is, try reading one of these bills . . .
. . . Keeping prices opaque is one way medical institutions seek to avoid competition and thereby keep prices up. And they get away with it in part because so few consumers pay directly for their own care—insurers, Medicare, and Medicaid are basically the whole game. But without transparency on prices—and the related data on measurable outcomes—efforts to give the consumer more control over health care have failed, and always will . . .
