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Health Care in Need of a Fix
Unless there is systemic change, the system, is like the Titanic, headed for an iceberg
By Kathleen O'Connor
Originally appeared in Modern Health Care: April 8th, 2002 (page27)
From the so-called “Sons of Jackson Hole Groups” to the latest Blue Cross Blue Shield initiative, we are drowning in calls for new studies on healthcare costs and access. We don’t need new studies. We need systemic change.
Why? Because we don’t have a healthcare system: we have a business to business enterprise.
Employers buy health insurance and insurers sell it. Twenty percent of everyone under age 65 has no health insurance. That’s our healthcare system.
While we have Medicaid and Medicare, they are not linked in any systematic way to employers. Medicaid varies from state to state; it is not a standard plan with standard benefits.
Medicare covers acute hospital and some Skilled Nursing Facility costs, but otherwise covers virtually nothing that contemporary seniors need–prescription drugs and long-term care.
We also have the public health system, but it’s woefully under-funded and totally divorced from private commercial insurance.
When a cost crisis trots along, we resort to three standard solutions: cut benefits, cut dependents and cut rates. Sometimes we do all three. This is the healthcare shipwreck.
Employers use benefits to attract and retain employees. In fat times, they throw benefits at employees; then cut benefits or increase cost sharing when times are thin. In lean times, we end up with even more uninsured as businesses lay off employees.
The safety net we had 10 years ago is vaporware. Provider rates are so low in some states that many clinics won’t take Medicaid patients. In my state, a frightening number of primary care doctors no longer take new Medicare patients.
When healthcare costs increase, different regulatory or marketplace solutions erupt to quell those costs. Here’s the jargon soup we have supped on so far: DRG, RBRVS, PPO, HMO, POS and now DC, as in Defined Contribution. These “solutions” did nothing but shift costs from one sector to another.
No common language or world view–must less trust–exists among the crew and passengers on this healthcare Titanic. Businesses don’t trust hospitals and physicians, because they can’t get timely or consistently reliable information from them. Consequently, businesses make independent decisions for their own economic good or resort to hardball tactics like The Leapfrog Group initiative.
Employers are largely unconcerned about rates paid to providers because they consider doctors’ and hospitals’ inability to manage within these rates as simply bad management. So when they hear the ship has sprung a major rate leak, they have no incentive to listen.
Patients don’t know whom to trust anymore. It takes months to see doctors, their doctors often change when networks change. When they get to the physician’s office, they are lucky if they have more than 10 minutes with the physician they have waited weeks and sometime months to see. Hospital care is so stretched, patients fear for their lives. They don’t understand their hospital bill, much less an EOB. And we wonder why liability is so high.
Everyone is so busy blaming, cutting and shifting that we never discuss what is at the heart of the problem: we have a total and complete lack of vision about what a healthcare system should be and do.
You can’t build a ship if you don’t know it’s supposed to float. Which is why our healthcare Titanic system is heading for a shipwreck. We did not build the current system with an end view in mind. We built an employer-based system of insurance with public program props.
We are stuck with a business to business model in which healthcare benefits depend on where we work. We put the sick, elderly and poor into public programs, then wonder why those programs cost so much.
Healthcare as an employee benefit creates a ‘use it or lose it’ mentality and increases costs. I remember the wage/price freeze in the ‘70s when we were given full dental and mental coverage in lieu of wages. Everyone I knew rushed out to get crowns and find a shrink.
We can’t fix something unless we know what it is supposed to do. We have never as a society discussed what we want from a system of care. We backed into health insurance unintentionally and have proceeded willy-nilly buffeted by the latest acronym.
What we need to do is define what we want a system of healthcare to do and the health outcomes we want. Then and only then can we have goals and outcome expectations, truly have a system of care with sustainable financing. Then and only then will be able to work together to reach those goals and be able to assure the economic viability of our businesses, hospitals, clinics and patients and the health and well being of our people and communities.
Then and only then can we have what is totally lacking now: accountability and responsibility.
Kathleen O’Connor is a consultant and author: The Buck Stops Nowhere: Why America’s Healthcare is All Dollars and No Sense. Kathleen@oconnorhealthanalyst.com or call: 206-217-9430.
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