On Monday, President Obama announced a $2 trillion dollar decrease in health care spending over the next ten years. The health care industry made a pledge to this goal by committing to a 1.5% annual reduction in health care cost trends. The savings will contribute toward funding the $634 billion dollar price tag for universal coverage.
At last, health industry leaders are collaborating with policy makers on health reform. There is hope that all Americans will have access to affordable, high quality health care. But it doesn't take a book title to tell us that hope is not a strategy.
In business, a successful strategy starts with clearly defined goals followed by a well-designed execution plan. Only then can financial projections be reliably calculated.
The Administration's approach to health reform has goals (universal coverage) and a price tag ($634 billion dollars.) But, it is missing a critical element: there is no plan. Imagine building a house without a blueprint or buying a car without selecting specific features. Imagine buying a computer and committing to paying for a decade of unlimited software upgrades. Without a clear list of features and benefits, you cannot predict the price of a house, a car or a computer...or the cost of universal health care.
Coverage, not cost, should be the foundation of the debate on health reform. The essential starting point is defining the list of basic health services that need to be available and accessible to all Americans. Since there is no system with unlimited resources, we have to make decisions on what's covered....and what's not. Today, the Centers for Medicare and Medicaid Services (CMS) said they will not cover virtual colonoscopy, since "the evidence is not sufficient to conclude that screening CT colonography improves health benefits..." This is the type of comparative effectiveness that needs to be applied to the full range of health care services so that we only pay for care that has a meaningful impact on health. Who should make those decisions? A multidisciplinary cross-section of leaders and health experts who are not influenced by special interest groups.
Provider reimbursement approaches that promote evidence-based science, care coordination, and high quality outcomes are another essential element of health reform. In addition, payment systems need to reward providers who deliver a highly satisfying health care experience and inspire patients to care for themselves.
Reform should also focus on implementing public policies that make citizens accountable to their lifestyle risks and support communities in achieving health and well-being. This is an unprecedented opportunity to establish an integrated public health system across the US. Lets engage schools and educators to help promote healthy behaviors in our children. And lets leverage technology, such as telemedicine, to extend care to citizens living in remote or rural areas of the country.
While this disciplined approach to health reform may take more time, the operational clarity allows for more accurate cost projection. Ultimately, this helps ensure sustainable financing of health care coverage for all Americans. Conversely, taking a short cut generates headlines but has consequences. Today, Medicare trustees reported that the Medicare program will be insolvent by 2017. Without a comprehensive strategy, universal coverage will be soon be at risk for the same unfavorable outcome.
Let's not rely on using hope as a strategy. Rather, lets use "The Audacity of Hope" as our guidance: "If we don't change course soon, we may be the first generation in a very long time that leaves behind a weaker and more fractured America than the one we inherited." Lets change the course of the health care debate.
