Blueprint for an Effective and Sustainable Healthcare System

While the healthcare provider wants to give the best care and the patient wants to get the best care, the goals of the other parties, employers and insurers, are not aligned with either the patient or the provider. In fact, the goal of the insurer, to spend as little as possible on clinical care, often conflicts directly with the goals of the patient and the provider.

In our current healthcare environment, we cannot negotiate to the center of a table tilted heavily in favor of the health insurers whose goals are counter to the optimal healthcare transaction. That will only continue to promote a dysfunctional healthcare system. At best, it puts off the collapse of our healthcare system for a short time and benefits only a fraction of those it intends to help. At worst, it makes the needed reforms harder to achieve. As a result, we must first recognize where we are and identify what we want our healthcare system to look like in the future. Identifying the difference between the two (a "gap analysis") can help us to map out a plan for effective and sustainable reform of our system.

Below are the core problems which we must resolve to achieve an effective and sustainable healthcare system. The Possible Solutions do not pretend to be the best or only options. They are offered to suggest one possible general direction based upon the principles referenced at the end of this document.

Quality Limitations

Timeliness is reduced by unnecessary insurance company delays

Patients do not regularly seek prevention or screening services

Patients want freedom to choose, but are reluctant to accept the consequences of their choices

Providers may only give best care about 55% of the time

Limited data sharing and duplication of tests

Insurance policy variations make it difficult to select a policy or understand what is covered

Costs

The Emergency Medical Treatment and Active Labor Act of 1986 (EMTALA) siphons resources

Unreasonable expectations

Improved technology

Unreasonable Tort Law

Fiscal Crisis

The Medicare Sustainable Growth Rate (SGR) is bankrupting healthcare [6]

Insurance companies have antitrust relief while providers do not

Insurance companies take too much of the healthcare premium for bonuses and dividends

Insurance companies are incentivized to violate contracts and steal from providers

Rising healthcare costs will harm the general economy

When the military budget of the former Soviet Union approached 25% of their GDP, their economy collapsed. We are already seeing individual businesses (like GM and Chrysler) declare bankruptcy, in part due to rising healthcare costs. We cannot afford forever rising costs and must learn to utilize our healthcare budget more effectively. Insurance, which has progressively isolated patients from the actual costs of healthcare, has over three generations encouraged the American public to believe that healthcare is free. Whether or not we believe that healthcare is a right doesn't change its cost. Our right to an effective military is not free. Our right to free speech is not free. Healthcare is not and cannot be free.

Possible Solution: We must first recognize and then educate Americans that healthcare is not free. There is a cost and it must be paid by someone. There is a limit on how much care we can afford to provide for the fixed amount of dollars we as a population have chosen to spend together on insurance. We need to start spending more wisely, especially on preventive care and screening, where the return on our investment is highest. Data from the ARRA-supported cost effectiveness research may someday provide data that helps patients and providers to determine which treatment options to pursue.

As Albert Einstein has said, "We can't solve problems by using the same kind of thinking we used when we created them." Finding the solutions needed to ensure an effective and sustainable healthcare system will require a new way of thinking about healthcare and a new process for reform, ones we have not tried before. We recommend that this new thinking involve first identifying our core principles through consensus and only then trying to define the policies which promote and support the principles. This is why the Yuba-Sutter Healthcare Council has identified our key principles for effective and sustainable healthcare.

A government led consensus process might lead to a core set of principles that are different than ours, but they must be equally actionable to drive rational policies in support of the principles selected. How we solve the healthcare crisis will depend upon whether we agree to start with basic principles or whether each party simply continues to lob demands at the others. Once we identify our core principles, some of the policy choices will be clear and others will require lengthy discussion. We encourage everyone to ask Congress to consider this new approach to healthcare reform. We hope it is not too late to have an impact on the national debate. Please contact us with any thoughts you wish to share or any questions you wish to ask.

1. "Why Not the Best? Results from a National Scorecard on U.S. Health System Performance"
2. "Healthcare Reform: from Problem to Crisis to Solution"
3. "Computerized patient records improve practice efficiency and patient care"
4. "Bringing evidence-based best practices into practice: more than 600 Minnesota physicians put EBM to work"
5. personal communication, California eHealth Collaborative
6. Comparing the SGR and MEI
7. "AMA meeting: Delegates renew efforts for antitrust relief"
   "Antitrust Laws a Hurdle to Health Care Overhaul"
8. "Failing to Correctly and Accurately Pay Claims to Health Care Providers"

Healthcare Principles of the Yuba-Sutter Healthcare Council

1227 Bridge Street, Suite C - Yuba City, CA 95991 - (530) 751-8555 Copyright © 2007 - 2010 Yuba-Sutter Healthcare Council - All Rights Reserved.