From Sick Care to Health Care:  The 3-P Plan

Introduction:

It’s no secret our nation’s health care system is sick. We spend more than any other country on health care, but we routinely get poor results. [1]   Not only are 45 million Americans uninsured, [2] but life expectancy in the US also remains below most developed countries, and the majority of consumers are dissatisfied with the quality of the current system. [3] Despite America’s state-of-the-art medical science, the fact is that medical practice is channeled towards misplaced priorities. A recent report by the McKinsey Global Institute suggests that our country’s emphasis on pills, procedures, and paperwork results in as much as $480 billion wasted per year when the US spending is compared to other nations. [4] Rather than best utilizing our resources to promote health, we’ve created a “sick care system” that is simply not sustainable.

Despite these gaping wounds, timid politicians have resorted to mere band-aids that don’t address the underlying problems. They’ve created free-care pools for the uninsured, but haven’t done enough to prevent the uninsured from showing up at the emergency room in the first place. They’ve developed a Medicare Part D benefit to pay for some prescription drugs, but they’ve done little to reduce the high prices charged by pharmaceutical companies. They’ve offered health savings accounts to increase access, but they’ve simply shifted the burden of care onto the consumer. As a result, the problems of cost and access are only getting worse. At the current rates of increase, US health care expenditures will almost double to 4.1 trillion dollars in the next ten years. [5]  We can not afford to avoid this problem any longer.

A winning presidential candidate will have to offer comprehensive solutions instead of band-aids to transform our sick care system into a true health care system. We’ve had enough pills, procedures, and paperwork. Now it’s time for the other three P’s – preventive, primary, and patient-centered care. I propose a comprehensive, actionable plan centered on these three goals in order to start making the real change Americans are looking for.

Proposal:

Preventive Care
Any true health care system has to start with making people healthy. This means preventing people from getting sick in the first place. More than half of deaths in the US are caused by preventable factors, such as tobacco, alcohol, and obesity, [6] and consequently, the federal government has a huge potential to make a big investment in these areas which can yield even bigger dividends later. 

Of all preventable risk factors, obesity is one of the most pressing to address. Not only are an alarming number Americans affected by obesity and its consequences of diabetes, heart disease, cancer, [7] but obesity it has a larger impact on health costs than any other preventable condition. [8] In fact, virtually all of the increase in Medicare spending over the past decade can be attributed to obesity.  [9]

Countering the obesity epidemic is not easy, but we do have clear tools within our reach. The CDC’s Community Taskforce on Prevention has outlined criteria for multi-faceted interventions that the government can support. [10] More specifically, however, the federal government can and should take a leading role in subsidizing fruits and vegetables and improving the nutritional quality of federally subsidized school lunch programs. These actions offer the opportunity to not only save money in the long-term, but also the possibility to begin reorienting our health system towards what really matters.

Primary Care
While prevention is the first step, the fact is that people will get sick. In this case, we as a society need to be sure that there is an effective safety net to provide people care before they end up in the emergency room. At a minimum, we need to ensure primary care to every American.

The major barrier to access to primary care in this country is of course a lack of adequate health insurance. In addition to about 45 million uninsured, millions more middle-class Americans are also underinsured, and we all end up paying for this system later. In 2004, an estimated $41 billion was spent on uncompensated care in the emergency room, 85% of which was paid for by the government. [11] 

Proposals for addressing the problems of the uninsured are certainly numerous and they can quickly become exceeding complex. While it is out of the scope of this policy brief to detail all possible plans, I want to focus on the strengths and simplicity of the AmeriCare Health Act of 2006 proposed by Representative Stark (D-California). This plan is essentially a Medicare-for-all model that covers every American in a coordinated way while still maintaining patient choice of health plan and a choice of doctor.

According to an independent review by the Commonwealth Foundation, the public health impact of such a bill would be profound. Not only would the all uninsured be covered, but the plan is also estimated to cut total health spending by $60.7 billion, which is significantly more than any other health plan currently proposed, including attempts to extend the elements of the new Massachusetts health plan to other states. AmeriCare’s cost-savings are also spread out across the population so that every American would benefit. This isn’t socialized medicine but rather capitalism at its best – helping us to cut the waste and to start getting real value in our health care system.

Opponents may claim that any plan for universal health care coverage is unfeasible, but in the most recent poll, at least 60% of Americans say that they support universal health care and the additional taxes required to pay for it. [12] Key interest groups such as insurance companies and doctors will certainly have strong reservations, but with a clear plan that appeals to the best interests of all the American people, a courageous leader can mobilize others to make real change.

Patient-centered care
Believe it or not, however, simply granting health insurance to everyone doesn’t complete the transition from a sick care system to a health care system. We also need to ensure that this care is of the highest quality for all. In particular, we need to reduce the high number of medical errors in our country (one of the top ten leading causes of death), [13] and we need to cut unnecessary administrative costs. While quality care is often associated with expensive care, the fact is that there are several cost-effective reforms that we can make to reduce medical errors and improve value.

Electronic medical records can and should drive this transformation. The country that invented the computer and the internet should not be falling behind in this area, but we are. Only 16% of primary care physicians use electronic health records, [14] and less than 10% of hospitals have fully implemented health information technology. [15]  Moreover, most of these records are rendered relatively useless by the fact that many electronic records simply aren’t compatible with each other.

Fortunately, the federal government can take a leading role in implementing electronic medical records. Efforts are currently underway to facilitate this process, but ultimately clear national guidelines need to be given in order to ensure compatibility and protection of privacy. Under the AmeriCare plan outlined above, the federal government would be able to implement a comprehensive policy much more easily and would also be able to incorporate novel quality improvement practices such as pay for performance, which links physician salaries to improvements in the patient’s health rather than to the number of procedures performed. By harnessing the innovative power of technology, we can eliminate unnecessary costs, and bring medicine back to its core mission of putting patients first.

Conclusion:

In this plan, I’ve presented three guiding principles and several actionable steps, but in the end it all comes down to one goal – improving the health of every American. While any one of the steps above could be the subject of a policy brief all to itself, the synergistic quality of this comprehensive approach is essential to transcending band-aid-style solutions and to transforming our current sick care system. At the end of the day, a better system benefits everyone, and so I firmly believe that we can all come together in such a bipartisan fashion to move our health care system not left, not right, but forward.

The history of health reform in our country of course shows that change is not easy. Even if a system works well on paper, pressure from numerous interests groups will inevitably distract leaders from their central purpose of pursuing effective policies to improve the health of every American. Unfortunately, as the system gets worse, the billions of dollars of our money being wasted simply allow these interests to be even more entrenched.
 
The one power that we do have, however, is our democracy. It’s time to declare our independence from petty interests and to renew broad-based advocacy around the core principles of a strong health system. It’s time for a presidential candidate who will act with wisdom and courage to lead this movement. It’s time that we as a society succeed in creating a health care system that works.

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[1]  OECD Health Data 2006. Available athttp://www.oecd.org/document/30/0,2340,en_2649_34631_12968734_1_1_1_1,00.html.
[2]  Associated Press. “Census: Estimates of uninsured overstated by 2 million.” CNN. 23 March 2007. Available athttp://www.cnn.com/2007/US/03/23/census.error.ap/index.html?eref=rss_us.
[3]  “Health Care in America 2006 Survey.” ABC/ Kaiser Family Foundation/ USA Today. October 2006. Available athttp://www.kff.org/kaiserpolls/upload/7572.pdf. 
[4]  Angrisano, Carlos et al. “Accounting for the Cost of Health Care in the US.” McKinsey Global Institute. January 2007. Available at <http://www.mckinsey.com/mgi/reports/pdfs/healthcare/MGI_US_HC_synthesis.pdf>.
[5]   Poisal, John et al. “Health Spending Projections Through 2016: Modest Changes Obscure Part D's Impact.” Health Affairs Web Exclusive, 21 Feb 2007.
[6]  Mokdad AH, Marks JS, Stroup DF, Gerberding, JL. Actual Causes of Death in the United States, 2000. JAMA 2004: 291: 1238-1245.   SEE ALSO:  Mokdad et al. Correction. JAMA.  2005;293:293-294.
[7]  Hedley AA et al.  Prevalence of Overweight and Obesity among US Children, Adolescents and Adults, 1999-2002.  JAMA;2004:2847-2850.
[8]  Sturm, Roland. “The Effects of Obesity, Smoking, And Drinking on Medical Problems And Costs.” Health Affairs. Mar/Apr 2002.
[9]  Thorpe, Kenneth and David Howard. “The Rise In Spending Among Medicare Beneficiaries: The Role Of Chronic Disease Prevalence And Changes In Treatment Intensity.” Health Affairs. 25 (2006): w378–w388. Available at:http://content.healthaffairs.org/cgi/reprint/25/5/w378.
[10]  CDC Task Force on Community Preventive Services. Guide to community preventive services: What works to promote health? Stephanie Zaza et al, ed. (New York: Oxford UP, 2005).
[11]  Hadley, Jack and John Holahan. “The Cost of Care for the Uninsured: What Do We Spend, Who Pays, and What Would Full Coverage Add to Medical Spending?” Kaiser Commission on Medicaid and the Uninsured. May 10, 2004.
[12]  “Poll: The Politics Of Health Care.” CBS. 1 March 2007. Available athttp://www.cbsnews.com/stories/2007/03/01/opinion/polls/main2528357.shtml.
[13]  Institute of Medicine. To Err is Human. National Academies Press. 2000.
[14]  DJ Ringold, JP Santell, and PJ Schneider (2000). "ASHP national survey of pharmacy practice in acute care settings: dispensing and administration—1999". American Journal of Health-System Pharmacy 57 (19): 1759-75.
[15]  Johnston, Doughlas, et al. "The Value of Computerize Provider Order Entry in Ambulatory Settings: Executive Preview." WEllesley, MA: Center for Information Technology Leadership, 2003.