Given the ongoing debate around healthcare in the lead up to the 2020 election, we were recently challenged by a colleague to channel Vince Lombardi and come up with a few key “plays” or fundamentals that could get the US healthcare system onto the right track. So here they are,
- Insurance for all, with everyone in the SAME national health plan from birth to death. The following bipartisan principles should apply as the litmus tests:
- Everyone is insured
- Individuals own their insurance (eliminates job lock and reduces issues with care continuity); employers can still contribute to offset healthcare premiums is they so desire
- Choice of plans and options
- Government supported means tested premium support for basic packages, with the ability to buy up (and pay the difference out of pocket) should the individuals desire
- Sunset Medicaid and Medicare
- Pay for value. Base provider payments on the real costs that the highest value providers can achieve! Payments should be reality-based. Cease setting prices based on arbitrary price control mind set. Payments should allow the highest value providers to stay in business, cover their costs plus 2-4% margin. Relentlessly measure and monitor value among providers.
- Require interoperability in the digital healthcare infrastructure through regulations (accelerate implementation with funding if so desired), but stay out of day to day practice micromanagement (do not make the same mistake of previous “meaningful use” dictates). Place the “burden” of interoperability on software developers, rather than healthcare providers.
- Address the price of pharmaceuticals and accelerate the evaluation of all new technology through Coverage with Evidence generation programs for ALL new technology. The goal is to establish the role in practice for new technology, and continue to evaluate ongoing clinical trials to further refine the appropriate role: e.g.. beta blockers in MI and CHF (expanded role), and lung reduction surgery (restricted role). Consider pharma in the realm a regulated utility for both discovery and development (new drugs, vaccines, and novel diagnostics) and for ongoing production of generics.
- Move medical-legal matters in to a medical-legal court structure and incorporate the concept of a learning organization into this domain.
