Beginning with President Harry S. Truman proposing a national health system in 1949, the politicians have been fixated on money, where it comes from, how it is spent and how to organize it.

The tragedy with this myopia about finances is that most of the key breakthroughs we need in health are not a function of money. They are a function of focusing on new areas of health, and organizing and paying for better outcomes.

There are five big changes that could transform our health system and save both lives and money. Unfortunately, these five reforms are not “political” health issues, so reporters don’t ask about them and politicians don’t talk about them. But if candidates or lawmakers could outline how they would implement these five big reforms, it would create a new focus and set a new standard that would dramatically improve our system and the lives of millions of citizens.

The greatest challenge in health today is to invent a new payment system that rewards doctors, hospitals and individuals for wellness, early detection, disease prevention and chronic disease management. That means we have to focus on health first and health care second. If we took half the energy invested in the annual fight over Medicare payments for doctors and invested it in bold experiments with members of the American Medical Group Association — such as Virginia Mason Medical Center in Seattle and Intermountain Healthcare in Utah, as well as Wellstar in Atlanta, and Alegent Health in Omaha — we would dramatically lower costs while improving outcomes. Alegent literally pays enrollees in the consumer-driven plans $100 to take a health-risk assessment. Pays diabetics to enroll with a health coach. Pays them still more if they meet certain metrics. The results in health outcomes have been outstanding.
Wellness, prevention and better health start with more responsible individual choices. Just like the program former Gov. Jeb Bush began with Medicaid in Florida, which pays individuals for being healthier and more compliant with care. Congressmen like Michael Burgess, MD, fully understand the power and potential of saving lives and money through incentives. Before becoming a congressman, Burgess became aware of the importance of primary care, playing an active role in the diagnosis, treatment and prevention of osteoporosis. The cost of diagnostic technology was coming down, and for the first time there was a newer type of medicine that could reverse the effects of bone loss. Burgess used this information to convince his practice that providing this basic service was cost-effective and the correct type of intervention. They became the first, and only, site for this type of testing in north Texas.
Infectious diseases are literally killing tens of thousands of Americans both in hospitals and in our communities. MRSA, a strain of staph infection that is resistant to the antibiotics commonly used to treat it, now kills more Americans than HIV/AIDS. Congressman Tim Murphy (a doctor) has a powerful bill that would begin to establish standards for hospitals to avoid infections. It would clearly save a lot of lives and a lot of money.
Hospitals and medical groups should apply the insights of large-scale change as demonstrated in the Center for Health Transformation’s publication and subsequent workbook titled The Art of Transformation, which I co-authored with CEO Nancy Desmond. Then, they must learn the lessons of behavioral economics, employee engagement and customer satisfaction from Gallup, along with the efficiency and waste-reduction methods of the Toyota Production System, and the employee culture and training of the Ritz Carlton. With this culmination of knowledge, the result would be dramatically greater productivity and substantially higher patient satisfaction at lower cost than anything we have ever seen in the health system.
A truly effective health system has to have electronic data, and that means all Americans must have an electronic health record. Every successful modern production system and every highly accurate competitive enterprise (think UPS and FedEx, and see my YouTube video FedEx vs. Federal Bureaucracy for examples) relies on powerful flows of information in electronic formats. We need to commit to expanding health-information technology, which requires the government to make financial investments in health IT solutions proven to save lives and money. Instead, the Office of Management and Budget has been so reactionary it actually stopped the Department of Health and Human Services from allowing New Orleans to invest part of a $100 million health-care grant for health-information technology. In a recent visit to New Orleans, I was briefed once again on what a short-sighted, destructive policy OMB has imposed. This is an issue Gov. Bobby Jindal understands well, and Senator McCain would do well to make it a key plank of his health platform.

With electronic health records, we can begin to fight the fraud and corruption that are a cancer on our health system. The New York Times estimated in 2005 that Medicaid fraud in New York state was 10 percent of the total. That is $4.4 billion in New York State Medicaid fraud alone. Only an electronic health record system will enable us to apply modern anti-fraud measures and save money that could be used to help create a 100 percent insurance system for all Americans. “Less for the crooks, more for the poor” would be a pretty good battle cry.

These are five items you probably won’t hear about from Republican or Democratic politicians, but you should.

The best of both worlds

Democratic Sen. Ron Wyden of Oregon on the need for bipartisan solutions

Bipartisanship can be as rare as a cool breeze on a humid, summer day on Capitol Hill, but it’s something I believe in because it works. The biggest problems facing our country today won’t be solved unless Republicans and Democrats work together — and this is especially true of the crisis we face in trying to fix our nation’s broken health-care system.

The conventional wisdom has always been that the country and its government can’t afford to reform the health-care system. — Ron Wyden

In my mind, there is no issue more important to Americans than their families’ health. Yet today, most American families depend on an employer-based health-insurance system that is fading fast. Health-care costs are rising at more than twice the rate of inflation, which means that in the best-case scenarios, employers are being forced to raise co-payments or opt for cheaper insurance. In the worst-case scenarios, employers have no choice but to stop offering health benefits altogether. And too many Americans, like those recently laid off by General Motors, are discovering how hard it is to buy health insurance on their own.

Americans cannot afford to let this situation get any worse, which means that we must end the divisive partisan battles that have defined previous reform efforts. This is why I got to work early last year, sitting down with my colleagues from both sides of the aisle to find out what it will take to enact health reform in the next Congress when a new president takes office. So far, Sen. Bob Bennett, R-Utah, and I have assembled a coalition of eight Democratic and eight Republican senators — the first substantial bipartisan coalition for universal health care in the Senate since the 1940s — as co-sponsors of the Healthy Americans Act (S. 334).

The Healthy Americans Act takes the best parts of both political parties’ philosophies and uses them to solve our health-care problems. It weaves together the Democratic idea that every single person in the country should have health-care coverage, and the Republican belief in a private-market approach.

The Healthy Americans Act modernizes the employer-employee health-insurance relationship so that everyone has more choices. If employers still want to provide health coverage for their employees, they can; and if employees want to keep the coverage they currently have, they can do that, too. But it gives everyone a choice, guaranteeing that whether they have a job, lose a job or start their own business, every American will be able to afford quality, private health coverage that is at least as good as what is available to members of Congress today.

The Healthy Americans Act also reforms the private insurance industry. Insurance companies will no longer be able to compete to cover only the healthiest individuals. Rather, by requiring them to cover everyone (regardless of age or health status) at the same rate, insurance companies will have to change their business models so that they can compete for business on the basis of quality, cost and coverage. And because Americans will have greater power to choose, insurance companies that deny coverage and fail to provide quality service will fast find themselves without customers.

Just as few think that Democrats and Republicans can agree on anything regarding health care, the conventional wisdom has always been that the country and its government can’t afford to reform the health-care system. This was proven untrue earlier this year when the Congressional Budget Office and the Joint Committee on Taxation — the government’s go-to experts on budgeting and taxes — issued a joint analysis that found the Healthy Americans Act would not cost any additional federal or taxpayer money once it’s up and running and, in fact, would save taxpayers money in the future.

Best of all, the bill focuses the system on keeping Americans healthy by giving insurance companies and individuals financial incentives to encourage healthy behaviors, more access to preventive services and better management of chronic illnesses. It also would provide financial reimbursements to Medicare providers who manage their patients’ chronic care needs, which will be increasingly important as treatments for once-terminal illnesses, such as cancer, become more common and patients live longer.

Under the Healthy Americans Act, individuals will designate a “Health Home” for themselves — a health-care provider who will monitor their health, coordinate their care and establish a care plan to maximize their health. Other provisions will reform medical liability laws, which will aid doctors by reducing the practice of so-called defensive medicine. These reforms will free up doctors to treat patients and prescribe medications without fear of frivolous lawsuits.

The Healthy Americans Act offers something for everyone involved in our health-care system, and that’s a direct result of its truly bipartisan nature. In that way, it reflects the diversity of the people it seeks to serve: the melting pot of Americans. Any real health-care reform that has a hope of becoming a reality must respond to the wide range of Americans’ needs and ideals.

In a few months, Americans will have new leadership in the White House. Our bipartisan goal is for the new president to see the Healthy Americans Act as a starting point for bringing Democrats and Republicans together to address the nation’s health crisis. It is a daunting task, but one that America desperately needs to get done.

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