THE GREAT BOOGEYMAN
Ever since the Clinton era when the Healthcare crisis was to be solved in 100 days, the Universal Healthcare flag has evoked strong opinion. It centers on the Healthcare Triangle of Control: Access, Quality and Costs. Who you are and your vested interest, generally shapes your position of why we need it, why we don’t and who should or can pay for it. It is an issue that won’t go away.
The discussion on our national stage is part of the current divisive presidential campaign. At the state level, it’s budget discussions for government programs. At the local level, a cross section of community leaders said it was near the top of their list for required action. So let’s deal with the matter.
When the pressure gets our legislators to act, they stumble their way to such convoluted solutions as HIPPA or Medicare Part D. They don’t seem to understand that if you want efficient and cost effective programs they have to be simple.
With the amount of money involved with healthcare, no-one wants to sit on the sidelines, for fear they might not get their share or they might lose what they have. We must all recognize that with the current system we are all loosing something. We must stand back, start over and create a simpler system. Then maybe most of us can win something.
The one principle set of losers: Those who make “tons” of money administering the payment plans or designing the plans to work within the current bureaucratic system. Unfortunately, these big-time administrative organizations have the funds and/or influence to shape the system when our politicians start to address the “Triangle of Control”.
The key is to look at each element of the “Triangle” and find a simple concept to use as the guiding principle for all subsequent decisions; then fit the three key components into a holistic system, and minimize unintended consequences. Once the system is set up, the people involved with the healthcare system are all very smart and will figure out how to “work” the system.
The “Triangle” Key Components:
Access - everyone needs some level of healthcare. Subsidized care should be provided only to legal citizens with the exception of life threatening conditions. This takes regular care away from emergency facilities and puts control into lower cost primary care, protects hospitals and care providers and gets treatment on a timely basis and eliminates the numerous supplemental special interest programs.
Quality - the biggest Boogeyman, assumes that in a universal plan all the incentives go out of the system and therefore the providers won’t do a good job or new inventions, drugs or techniques won’t be created. Informed leaders know there are multiple motivators. With some reasonable emphasis on outcomes, there can still be monetary incentives for those who demonstrate success.
Cost - the real divisive issue. Who should pay for the care? In the current system, we are all paying for it; some more than others. We are paying for it through ineffective administration, uncompensated services, untimely services and defensive medicine to avoid blame. This doesn’t even consider losses in worldwide competition due to high cost healthcare being factored into our products and services pricing.
A needs based system as opposed to “ability to pay” system with cost sharing between individuals, employers, and government, just like social security, can be a solution. Establish charge and payment practices by services types, i.e. basic, intermediate and specialty. Then establish funding plans that correspond appropriately with services rendered, with the employee picking up a substantial portion of basic services and government handling more of the expensive services. Employers should have a fixed predictable fee base. This puts the burden for lifestyle and management on the individual with safety nets on costs. Payment strategies can be utilized for low earners. Uniform pricing with simple structures like Medicare supplemental plans,enhance understanding and limits administration expense.
Standardization that gives access, takes cost out of the system, and spreads the responsibility, can also provide focus on outcomes and appropriate rewards. Once designed, the real challenge is the transition plan. Solution: a series of fixed, modest sized steps over an eight year period.