All kidding aside, our healthcare system is limping along with a very expensive price tag and yet we are still in a quandary about what to do! It is interesting (and a little bit scary) to watch the contentious debate over how and if we should change our healthcare system. It is my sincere belief that if you polled most Americans they would say that they believe healthcare is a right (at least a basic set of services) and not just a privilege. I also believe most Americans would recommend, at a minimum, inclusion of the following healthcare provisions in their healthcare system:
1) Reasonable access to routine & emergency care
2) High quality care provided
3) Affordable care or at least a reasonable out of pocket cost for their families
4) Lastly, a healthcare system that would avoid a total loss of all they have acquired (their homes, their savings, and their retirement accounts) if they or their family members have an unforeseen catastrophic event (very costly hospital stay or long term chronic illness or accident).
So the real trick to providing all of these services comes down to how do you create, package, deliver, and pay for such a healthcare system that ensures access, quality, and affordability for all Americans as well as safeguarding these individuals from a financially catastrophic healthcare event. In other words, what is the acceptable healthcare benefit plan that can cover all Americans at the best price or a least at a price that Americans (taxpayers) can afford (biggest and best bang for the buck)?
Normally, the politicians do a great job of espousing a Grand Vision for changing the healthcare system, (no loss of benefits, no pre-existing conditions clauses, no requirements to change physicians, and so on), but they are generally very vague on the actual details on how to achieve such a Grand Plan, especially when it comes to paying for these changes and who will bear the responsibilities of implementing the changes or earmarking the funds to fully pay for these changes. As it is with most strategies & plans whether it is in healthcare or any other industry, “the real work is in the details of the plan!”
Just A Few 'Small' Details that need to be Addressed
Some of the major issues or details that must be considered:
• Should we attempt to provide healthcare (and or healthcare insurance coverage) to 100% of all Americans (is it a right and therefore an obligation to provide to all citizens)?
• Should we examine (and perhaps model or adopt at least successful parts of) other healthcare systems (e.g. Netherlands, Australia, Sweden, Canada, etc.) to possibly realize some of the benefits and shortcomings of systems currently being tested?
• What should be included in a basic healthcare plan for all American (wellness care, preventive care, mental health, long-term care, routine care)?
• Should we continue to provide coverage through an employer-based healthcare system?
• Should we have a one payer system or multiple payer system?
• Should we create policies and regulations to further control insurance companies?
• How do we ensure quality of care for all and the elimination of medical errors or mistakes?
• Should we have a federal limit on medical malpractice claims and do we need to reform the healthcare legal system?
• How much should each individual pay out of pocket in order to control excessive overutilization?
• What is the best method to reimburse clinicians and healthcare facilities (managed care, capitation, fee-for-service, etc.)?
• Should the government (taxpayer) pay for individuals who cannot or will not pay for their own healthcare?
• Should health benefits remain tax deductible to both employers and individuals or should they be taxed?
• Should we community rate individuals or experience rate them when determining their premium rates?
• Should we pay for all medications or just selected ones (e.g. inpatient vs. outpatient, maintenance vs. acute vs. chronic, generic vs. brand name, over-the counter, vs. prescription, etc.)?
• Should we continue to adopt new healthcare technologies that are expensive and may have marginal benefits? How should medical technology acquisition be controlled?
• What is the most appropriate mix of copays, deductibles, co-insurance, premiums, medical savings accounts, and other payment rates should we implement to achieve maximum effectiveness and efficiency while avoiding overutilization and underutilization?
• Should we continue to ration healthcare by price and access or should it be rationed by another means, if at all?
• Should we force stronger competition among healthcare providers and insurers?
• What is the best way to pay for the changes and improvements to our healthcare system without further burdening many future generations?
In most of the recent debates regarding our healthcare system, few if any discussions are centered on evidence-based support of what has worked in other countries. While most Americans believe that our healthcare system is definitely not perfect and may need some form of serious repair, the questions and issues listed above must be thoroughly examined and constructively discussed (and evidence on appropriate solutions presented) before a major overhaul of our healthcare system is attempted. These are a few of the many issues that are explored in the healthcare management concentration within the MBA Program at Belmont University. Please leave a comment below or email me your thoughts.