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A 21st Century Health Care Roadmap: The Path from Peril to Progress

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By Susan Blumenthal, MD and Denis Cortese, MD.

A Commission of national health care experts convened by the Center for the Study of the Presidency and Congress (CSPC) has unveiled a roadmap and integrated approach that will help to put "health" back into our nation's health care system as well as address key opportunities following passage of health care reform legislation.

The CSPC Commission on U.S. Federal Leadership in Health and Medicine: Charting Future Directions has released its second report, A 21st Century Roadmap for Advancing America's Health: The Path from Peril to Progress, emphasizing a comprehensive spectrum of actions to build a 21st century system that will make America the healthiest nation in the world. Already, the CSPC Health Commission's proposals have helped shape new Federal initiatives and are reflected in recent health reform legislation.

Now that historic health care reform legislation has been passed, it is critical to examine the next steps necessary to ensure that all Americans gain maximum value out of our current health care system, and that all of the key elements necessary to improve the health of the nation are addressed. While the United States spends over 17 percent of GDP on health care--nearly twice as much as any other nation--it ranks only 49th on life expectancy, and Americans get the right treatment just 55 percent of the time.

Simply put, Americans are paying far too much on health care delivery, especially when compared to the outcomes, safety, service and access we obtain in return. Low value health care in the United States is the result of the lack of a national and rational system for delivery of reliable high quality care. In order to enable the evolution of such a system, we need to find ways to consistently pay for value, which means paying for results.

There is a need to redesign the U.S. health care system to make it more efficient, effective and equitable for all Americans. This will require mobilizing every sector of American society as well as weaving health into the fabric of all Federal agencies to build a modern, 21st century U.S. health care system following passage of the reform legislation.

The Commission's report proposes a prescription of actions to modernize the U.S. health care system, moving it from peril to progress, by focusing on four key areas:

* Re-engineering America's health care system
* Advancing public health and prevention in the United States
* Promoting global health and health diplomacy
* Strengthening U.S. medical and public health research

To truly improve health and health delivery in the United States, we must make value be the cornerstone of a re-engineered system to improve quality, minimize waste and lower costs. The keys to accomplishing this transformation include the adoption of new value-based payment methods, promoting team-based medicine, strengthening primary care, and conducting comparative effectiveness and health systems research.

Another key component of transformation is building a health information technology infrastructure. Just as President Eisenhower built a Federal Interstate Highway System to connect communities, boost the economy and protect national security, so must we construct a health information superhighway system in the 21st century. Why is it that all Americans can have 24-hour access to their bank accounts from anywhere in the world yet there is no information technology system in place for electronic health records to improve quality, effectiveness and medical decision making? Such efforts to integrate health information technology will be boosted by a historic investment of $19 billion in the recent ARRA legislation (the "stimulus package"), compared to $111 million in the previous fiscal year. Another Commission recommendation that will be facilitated by health IT includes the establishment of a Federal Aviation Administration analogous Center in an agency of the U.S. Department of Health and Human Services to report, monitor and reduce the more than 1.5 million injuries and 100,000 deaths that occur annually due to medical errors.

Public health and prevention are also essential elements of health care reform. While more than 75 percent of health care costs in the U.S. resulting from chronic diseases that are linked to preventable factors, only 3-5 percent of the nation's health budget is spent on prevention. There is an epidemic of chronic disease in America, with more than a million Americans who die prematurely every year due to health damaging behaviors including smoking, poor nutrition and lack of physical activity. Obesity rates have tripled in the past 25 years, threatening our nation's future. If we continue on this path, the economic costs are unsustainable and for the first time in our nation's history, this generation of children may not be as healthy or live as long as their parents.

The report commends the establishment of a Federal Prevention and Wellness Fund in the health care bill (recommended in the Commission's first report) to support innovative community health programs. It also proposes launching national health education campaigns to promote healthy lifestyles, creating an interactive online health hub for best practices and health information, extending the Congressional Budget Office timeframe to 20 years for scoring cost savings of prevention, and establishing mechanisms to coordinate Federal programs to ensure that public health and prevention are cornerstones in the implementation of health care reform legislation.

The Commission recommends that the President issue a "Call to Action for a Healthier U.S." and deliver an annual State of the Nation's Health address describing the health status of the nation including progress on implementation of health reform.

Additionally, in an interconnected world, America's health is inextricably linked to global health, with humanitarian, economic and national security implications. The spread of infectious diseases such as AIDS and pandemic flu, the safety of food and the water supply, and the spread of tobacco use and obesity do not respect national borders. Yet, federal investments in global health account for less than one percent of the U.S. budget. The Commission recommends creating a 21st century U.S. Strategy for Global Development and Health Assistance, developing a Federal interagency collaborative framework, harnessing health diplomacy as a tool of "smart power" and working multilaterally with international institutions to advance science, medicine and public health in the developing world.

Lastly, investing in U.S. funding for biomedical and public health research, and the training of new scientists in health and medicine, are essential to strengthening and securing America's future. Investing in research is the foundation for all health and medical interventions, serves as a cornerstone of health care reform efforts, and is an engine of job creation as well economic and societal progress. Yet, in recent years, funding for research has been declining. Furthermore, America has seen a slow, steady erosion in its homegrown scientific talent base. As of 2003, only 12 percent of all college graduates held jobs in the fields of science and engineering. The Commission underscores the urgent need for sustained, predictable funding streams for research, science education beginning in elementary school, and a range of incentives and mechanisms to attract young people to research careers.

By building on these four pillars, the United States can move on a path from peril to progress, creating a modern 21st century health system. We stand at a turning point in America's health. Now is the time to work together to move our nation toward a healthier and more prosperous future.

To access a copy of the CSPC Health Commission's second report online, please click here.

Rear Admiral Susan Blumenthal, M.D. (ret.) is the Director of the Health and Medicine Program at the Center for the Study of the Presidency and Congress in Washington, D.C., a Clinical Professor at Georgetown and Tufts University Schools of Medicine, and Chair of the Global Health Program at the Meridian International Center.

Denis Cortese, M.D. is the former President and CEO of the Mayo Clinic. Currently, Dr. Cortese is a Foundation Professor at Arizona State University (ASU) in the W.P. Carey School of Business and the Ira A. Fulton School of Engineering as well as the Director of ASU's Health Care Delivery and Policy Program.

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