Road to Reform

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Commentary on The Commonwealth Fund/Modern Healthcare Health Care Opinion Leaders Survey on Priorities for the Obama Administration by Max Baucus, Senator from Montana

America faces grave challenges in health care. Today, about 45 million Americans are left uninsured and 25 million more don't have enough insurance to keep their medical bills from putting them at risk of bankruptcy.

Still, the U.S. spends $2 trillion a year on health care—a number that is expected to double in the next 10 years. Health care spending in America is greater than in any other nation, but our quality and value are far from the world's best.

Among 19 Western nations, the U.S. ranks dead last in preventable deaths. Americans receive the recommended care only half the time. If this country doesn't start getting a better return on our health care investment, it will be impossible to fully remedy the economic crisis or make America competitive in the global economy. The time to act is now. Plans to reform the system must target the overarching issues of the broken health care system: access to health coverage, rising costs and low-quality care.

Successful reform means ensuring that all Americans have access to the health care they need. As long as some part of the population is uninsured, the cost of their care will still be passed along to those who are covered in the form of rising insurance premiums, and costs will continue to grow.

Insuring all Americans is key to controlling costs, but it is also a significant challenge that will take cooperation. To get there, individuals should have a responsibility to secure coverage and businesses large and small should have a responsibility to help make that process work effectively. Nearly all large companies already provide insurance for their employees, but for small businesses and self-employed workers, being able to afford coverage is often a heavy lift.

Reforming the individual insurance market and setting rules for insurance companies that are fairer to patients—such as accepting all patients regardless of pre-existing conditions —will connect people to an insurance plan that fits their needs and budget. Along with strengthening the safety net for the lowest-income Americans through programs such as Medicaid and the State Children's Health Insurance Program, finding ways to reform the market for small businesses and individuals will move millions of uninsured Americans into good, affordable plans.

Although increasing access to coverage can reduce the immediate cost of providing care to the uninsured, health care reform must also address the significant growth of health care costs throughout the system. Health care makes up more than 16 percent of our gross domestic product, and by 2017, health care expenditures are expected to consume nearly 20 percent.

The rate of growth in health care costs has increased far more rapidly than the general rate of inflation, with health care costs growing at an average rate that is 2 percent above that of the gross domestic product for the past 30 years. Health care reform must bend this growth curve.

Initiatives to improve efficiency will reduce waste and save money in the system. Strengthening the role of primary-care doctors ensures resources such as specialists, scans, tests and treatments will be used more effectively within the system. Access to primary care that successfully manages and coordinates patient care is a proven determinant of high-quality, cost-effective care. Yet America's current system undervalues primary care relative to specialty care.

Reforming the system—using doctors' payments in Medicare and other means to improve the value placed on primary care—will give medical students an incentive to choose primary care and increase the availability of this valuable service for patients. Coordinating a patient's care among various physicians and facilities will not only save money in the system, but also will increase the quality of care.

Improving quality of care is essential to increasing the value of America's health care investment. We cannot afford to continue to receive such poor returns. Efforts to improve quality—such as using health information technology that can give doctors up-to-the-minute data and resources—will give our system a greater bang for the buck.

And the ways to improve quality are numerous. Gathering and sharing information on which treatments are most effective will help doctors and patients know what works best and will reduce wasted time and money on ineffective remedies. Basing federal payments to doctors on the quality of care delivered instead of the volume of care will provide an incentive. And, providing higher payments for doctors to work with specialists, hospitals, rehabilitation facilities and other providers ensures more coordinated and efficient care.

Taking steps to improve quality of care will allow more health care dollars to be spent on other priorities, so that down the road we will be spending what is currently projected, but our health care dollars will go a lot further.

Reforming the health care system is one of America's greatest challenges, but it is certainly also one of the nation's greatest opportunities. Without reform, America will not be able to surmount challenges on Wall Street, businesses will be unable to compete in the global marketplace, federal deficits will continue to rise, and opportunities to invest in other national priorities will be missed.

Swift reform is crucial. Equally as crucial is that reform must be comprehensive. The recent economic climate has some observers asking if there are elements of reform that should be delayed, questioning if some are more critical than others. What this question fails to recognize is that each of the priorities is important and relies on the others.

Increasing access to care, improving quality in the system, and lowering costs are all related. Investing in disease prevention, for example, can lower costs down the road, but those savings will be eaten up quickly if the system is still paying for uninsured patients to receive expensive emergency-room care.

Together, policies that target America's greatest health care challenges will result in a system in which all Americans can access appropriate care, costs are affordable enough for working families to manage, and the quality of care is unsurpassed anywhere in the world.

The views presented in this commentary are those of the author and should not be attributed to The Commonwealth Fund or its directors, officers, or staff.

Publication Details

Publication Date:
January 1, 2009
Citation:
M. Baucus, Road to Reform, Modern Healthcare and The Commonwealth Fund, January 2009.

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