03/18/2010 05:12 am ET Updated Nov 17, 2011

Point 1: Universal Coverage Is Needed To Reform Care

We can't fix care in America until we have universal coverage. We can't afford universal coverage if we don't fix care. They are a package. They both need to be done. Done well, both universal coverage and care improvement can be huge successes.

Why can't we fix care until we have universal coverage? Because people need coverage and care continuity in order for care improvement strategies to have a context and a cash flow to make them successful.

Care is broken in America because no one right now is accountable for fixing care.

Diabetics consume roughly 32 percent of all the costs of Medicare. It's the fastest growing disease in America. It's the number one cause of blindness, amputations, and kidney failure. The American infrastructure of care gets care right for diabetics less than eight percent of the time. What does right care look like for diabetics? It's not isolated, unconnected, and uncoordinated pieces of care. Diabetics need team care. We don't have teams of caregivers as the foundation of American health care delivery.

We need someone accountable for making care better for diabetics. When people have coverage, lose coverage, have coverage, lose coverage, there is no continuity of data and generally no continuity of care. Lifetime diseases need long term continuity of care. We absolutely need universal and continuous coverage to make that care continuity happen.

Asthma is the fastest growing disease for kids in America. It's the number one cause of death and the number one cause of hospitalization. We have no plan or strategy or tool kit to make care better for kids with asthma in America. What we do know is that barely 46 percent of the kids with asthma get the right care.

Again, we need universal coverage. If a child has coverage, then loses coverage, then has coverage, then loses coverage -- and goes from caregiver to unlinked caregiver for their care -- from emergency room to pediatric intensive care room -- no one today is accountable for making care better for those children and care will not get better. Wishful thinking will not create care improvement.

We need continuous care. We need continuous medical information. We can't get either one of those consistently if we don't also have continuous insurance coverage.

If we do have continuous coverage, we can then make sure that whoever pays the claims for each child must keep a database that can help support care improvement for each child.

If we start with the goal of making asthma care better and do it in the context of continuous coverage, we can move key pieces of asthma care from $10,000 or $20,000 per visit emergency rooms to $80 per visit primary care sites -- and provide much better care.

Cutting crisis level asthma attacks by 50 percent to 90 percent can save a lot of money. That money will not be saved if kids don't have continuous coverage and if kids don't have closely linked continuous care.

Care improvement is possible. Several very powerful studies have shown that up to $500 billion dollars a year could be saved if we got care right for all of our chronic care patients. Saving less than half of that money would completely fund universal coverage and make care and insurance premiums less expensive for every American.

Administrative savings based on administrative simplification can add another $50 to $100 billion a year to the savings pot for America.

None of those savings are possible until we cover everyone and do it in a way that improves care. Universal coverage is needed. Care improvement is needed. Both are possible. Neither can succeed alone.

Let's link them up and make them both happen.