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Fixing Core Issues ‘Upstream’ will help Reduce Healthcare Costs

HHRI 'Fragmented Delivery System' 2014I’m far from being a political junkie. In fact, watching sausage being made is more gratifying than watching the legislative process in Washington D.C. – especially when it comes to health policy issues.

In late July, I attended a healthcare symposium arranged by the Iowa Association of Health Underwriters. Jesse Patton and his team did a wonderful job of mixing local with prominent national presenters. One particular speaker, Grace-Marie Turner, president of the conservative-leaning Galen Institute, gave an informative presentation and followed up with this question to the audience: “What fresh ideas and a new vision might you have for lawmakers to consider regarding healthcare reform (presumably following the 2014 and 2016 elections)?”

Grace-Marie asked an interesting question, and this one got me thinking.

Regardless of our political leanings, we can all agree that the Affordable Care Act (ACA) is very complex and the long-term outcomes are uncertain. We can agree that the path we are on is unsustainable for many caustic reasons. We have little systematic health policies, just band-aid approaches that mask symptoms of gigantic problems undermining our economic (and physical) well-being.

In addition to covering more Americans, the ACA has attempted to address the ‘downstream’ activities of ‘Our Health Care River,’ basically determining who should pay and by how much. This discussion is extremely divisive because it becomes muddled by partisan philosophies so toxic that any potential progress is quickly thwarted. As a result, the common good of all U.S. citizens becomes a pawn within the political playground. We have been down this road countless times and it is extremely difficult to accomplish anything of great substance. It is so much easier to disagree than to agree. And, as a consequence, we all lose.

We have become so fixated on cost (and access) issues that we lose sight of the primary source of this cost — the healthcare we receive from those providing it.

Unfortunately, very little policy-making attention has been spent ‘upstream,’ which is the primary reason we are drowning in high healthcare costs (and insurance premiums) in the first place. Upstream problems should be a non-partisan issue. Because of this, we must agree on some fundamental issues that impact what we eventually pay downstream. So what are the core issues that will allow both political parties to find common ground and begin the change process? Here are a few…

We must:

  1. Have complete transparency in medical costs and outcomes.
  2. Address poor coordination of care among providers.
  3. Identify and fix the reasons why recommended care is alarmingly low.
  4. Remove the waste and inefficiency baked within our healthcare costs that we eventually pay “downstream.”  When you factor in the loss of productivity due to medical errors, this equates to at least a trillion dollars annually – at least 40 percent of all health costs!
  5. Develop and implement approaches to unmask and eliminate the medical mistakes that occur each year in our hospitals – which result in hundreds of thousands of needless deaths. In addition, 10-to-20 fold more are seriously harmed due to medical mistakes – in just our hospitals. Eradicating simple medical mistakes from our healthcare delivery system will provide safer care while eroding medical malpractice claims.
  6. Identify and resolve the misalignment of payment to healthcare providers. This has created perverse incentives that result in overtreatment, undertreatment, and other unintended consequences that we can no longer afford. We can all agree that fee-for-service payment measures must be replaced with sensible payment policies that promote incentives for performing the right care at all times.
  7. Address our unhealthy lifestyles which create additional pressure on an already dysfunctional healthcare ‘system.’ I know, this is easier said than done – but it is the truth. Developing a ‘social conscience’ about living healthier is a good start.
  8. Not allow lawmakers to be unduly influenced by lobbyists who compromise the well-being of our citizens. Washington (and state) lobbyists have perpetuated the ‘medical industrial complex’ that continues to eat up more of our gross domestic product.

Does this sound impossible to you?  Perhaps, but maybe not. For heaven’s sake, we put a man on the moon 45 years ago – and we did it by using technology from the 1960’s! We just need to have the political will, and frankly, a backbone to confront the brutal facts.

There are many other core issues that might be considered, but the above list is a good beginning on finding common ground. By addressing these issues, the cost to our system will drop markedly, making the political decisions downstream more manageable, and consequently, more favorable for agreement from both sides of the aisle. In fairness, the ACA attempts to address a few of these initiatives upstream, but most health experts agree that such programs will most likely have marginal consequences to the real problems occurring upstream.

Because our spotty health outcomes do not discriminate between classes of people within our country, policymakers must ‘think more like a patient’ and engage their efforts into reforming the core topics above. After all, policymakers are patients too. Carefully-derived factual data can guide and persuade policymakers to address these core issues. But it may take a “patient-like” mentality to properly motivate elected officials to do the right thing for all citizens.

If we continue our past practices in healthcare ‘policy’, we will replicate what baseball-great Yogi Berra was credited for saying: “It’s like deja-vu, all over again.” Our nation can no longer afford to continue down this dangerous road.

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Comments

  1. Kris Jensen says

    David,
    I attended the same conference and I couldn’t agree with you more. Love your list. Good additions to my benefit strategic thinking.

  2. Brad Johnson says

    I agree with Kris! The list is great!

  3. David,
    This is a terrific framework of ideas. This should be a “call to action” for policy-makers.

    • David Lind says

      Thanks, Andrew! I think most everyone agrees to this list, but then strange things begin to happen behind the scenes that undermine the direction to be taken. Like the ‘Man on the Moon’ venture, we must have a cohesive purpose AND the willpower to succeed. Not happening yet with health care, I’m afraid.

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