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

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

1. Everyone now living will die someday
2. Regardless of how much money we spend, we cannot change the first principle
3. The goals of healthcare should be:
   • promote positive lifestyle choices
   • prevent preventable illness
   • screen for early treatable disease
   • promote effective therapy
   • provide comfort when treatment is not an option
   • allow people to die in a dignified and comfortable manner
4. There is a fixed amount of money that can be spent upon healthcare, even if we choose for it to be 100% of GDP
5. We must optimize our healthcare budget in support of the goals of healthcare
6. Money collected for healthcare should maximally be spent on provision of effective healthcare services
Every Californian should be able to access a minimum level of healthcare services
7. No one should be precluded from paying for healthcare services that they choose to obtain in California
8. Patients should have some responsibility for their healthcare choices, so long as they are legally competent
9. Allocation of limited healthcare resources should be done in the most rational fashion that supports our goals
10. No party may dictate to another party what they may charge for their services
11. Sellers of services shall be paid by buyers (or payers) at the agreed upon rate or the seller's price when no agreement exists
12. Buyers (or payers) who were forced to obtain services in an emergency which limited their ability to investigate other options may seek a neutral third party to negotiate a reduction in a seller's price.
13. Provider pricing should be transparent
14. In recognition of the critical need for trained healthcare workers, some resources of the healthcare industry (insurers and providers) should be directed to support education and training for the development of the next generation workforce.
15. To ensure that a healthcare system endures in perpetuity, there must be:
    • adequate financial resources to support education and training of the healthcare workforce
    • enough clinical positions open to enable trainees to complete their practical training
    • strong incentives to encourage those capable of becoming healthcare workers to apply to do so

Individual principles taken out of the context of the whole, may not adequately represent the view of the Council. It is the Council's intention that all the principles be considered together as a unit in any healthcare policy discussion.

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