Things Are Going to Get Interesting

Sue Bergeson Health Guide
  • Bill Emmit, CEO of one of the largest and most influential mental health lobbying groups in DC, recently sent an e-mail to the CEOs of all the organizations who are part of the lobbying group, Campaign for Mental Health Reform. In his message, he attached part of a story from The Washington Post. 


    In the story, writer Lori Montgomery notes that DC "think tanks" and policy bodies are beefing up their health care staff in an obvious move to prepare for intensive work fixing our broken health care system during the next administration. For example, she notes that "The Congressional Budget Office has nearly doubled its health policy team, hiring 21 people in the past year. The Brookings Institution has snatched up more than a dozen researchers for a new center devoted to health-care innovations."

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    Why the flurry of activity to "fix" health care? 


    • 47 million people-16 percent of the U.S. population-do not have health insurance.
    • Spending on health care already consumes more than 15 percent of the nation's economy and about a quarter of the federal budget.
    • As a population, we spend more money on health care than on either housing or food.
    • Health care spending is growing at a rapid pace, exceeding GDP* growth by about 2 1/2 percentage points, on average, over the past four decades. If that pace continues, health spending will exceed 22 percent of GDP by 2020 and will devour half of all federal spending by 2050.

    *GDP stands for "gross domestic product," which also means "gross domestic income."


    And while we all cheer the progress in Congress of mental health parity, what will that mean in a broken health care system?


    Managed care—long thought to be the salvation of the health care system—turned out not to work. As the bumper sticker says, "Managed care is neither." More managed care seems unlikely to provide greater cost effectiveness.


    Long touted by the Republican side of the fence, health care savings accounts have not caught on. Why anyone is surprised by that is beyond me ... as a country, we don't tend to save money for anything, let alone set aside pre-tax dollars to cover out-of-pocket health care expenses.


    So, it's time for new solutions and, clearly, policy makers are gearing up for just that. What could we see in the future? 


    A trend we're seeing and hearing a lot about is tiering low costs/high quality providers.  Tiering, or incentivizing, providers who provide both high quality and low cost seems risky at best. A tiering program would do two things: It would pay certain doctors more, and it would encourage you and me to see these top-tier doctors by reducing our co-pay when we do. If insurers pay doctors who have lower costs and more great outcomes, will those doctors start to "cherry pick" only the "least ill" among us so they can keep those low costs and high outcomes? Will that mean that those of us with chronic conditions—say, like, mental illnesses—be left out in the cold with higher co-pays and lower quality doctors? And who determines how quality is defined anyway?


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    Some are predicting a state-based national health care system that makes this a part of our tax system and not part of our employment package. This would mean that everyone in a state or region is covered by a single insurance provider who bids for that business through the state. This would keep insurance companies in business and would ensure that everyone has health care. This might reduce some physicians' costs since they wouldn't have to track multiple payers and systems in their practice. It might also help integrate care among providers since, presumably, there would be one single data system and electronic record used across the board for each person.


    Some are predicting a more radical national system of health care ... something with reduced provider reimbursement, similar to what Canada has. 


    Personally, I have yet to hear of a possible solution that sounds reasonable or even doable.


    No matter what happens, the next six years are bound to be critically important to those of us committed to changing the health care system. And the only thing I can currently predict is that they system will not look or act the same when we're through. Things are going to get interesting.


    What would be in your dream health care system?


Published On: June 25, 2008