Archimedes Movement Community Leadership Council member Jason Gingerich passed along this link to a story on National Public Radio’s All Things Considered. Jason wrote, “The highlight is that the Obama administration sees the need for reform of the delivery system as one area where bipartisan agreement exists.”
Until recently, it seemed like Archimedes Movement members were the only ones talking about the need to remake our health care delivery system in order to improve health outcomes and control costs. Everyone else was just talking about broadening coverage and arguing about how we might pay for this expanded converage.
Now, there seems to be a growing consensus that we need to rethink the health care delivery system that we are buying with our huge health expenditures.
You can listen to the radio story here.
Below is a recap of the story.
Some Common Ground Ahead of Health Care Forum
All Things Considered, March 4, 2009President Obama is hosting what he calls a health care forum at the White House on Thursday. It’s part of his ambitious goal of getting Congress to overhaul the nation’s health care system this year. How that will happen remains politically complicated – but there’s at least one area of bipartisan agreement.
The current White House has a fair share of veterans of the last, unsuccessful fight to remake the health care system, including Chief of Staff Rahm Emanuel. But they’re already doing things differently this time around. They’re not writing their own legislation, and they’re not doing things behind closed doors, White House spokesman Robert Gibbs notes.
“The event will be streamed on the Web and broadcast on C-SPAN, as the president promised many times during the campaign,” Gibbs said at a briefing Wednesday.
Additionally, the White House has invited 120 people to the forum – lawmakers, patients and representatives of medical, business, insurance and other groups. The list also includes many who don’t agree with Obama’s approach to the issue. Gibbs says that’s no accident.
“The hope is to get all of those people in the room and talk best about how to get to the ultimate outcome of reforming our health care system,” he said.
The Cost Of The Payment System
But the administration does get to start with one area of agreement: fixing the way medical care is organized and provided at the patient level.
“How we deliver the health care is the real problem in the U.S.,” says Douglas Holtz-Eakin, the former head of the Congressional Budget Office and adviser to Republican Sen. John McCain of Arizona. “We need to change how much we spend and how we spend it so people get better health care.”
Holtz-Eakin says that when it comes to health care, fixing the way care is delivered is something Republicans and Democrats can agree on.
“I’d love to start with the delivery system,” he says. “It is the problem, there is bipartisan agreement it is the problem, and there’s agreement on some of the solutions.”
A major cause of that problem is the payment system for health care, says Elliott Fisher, a physician and researcher at the Dartmouth Institute for Health Policy.
“The payment system treats each physician and each physician’s service as a separate service that requires a separate bill,” Fisher says. “So the payment system does really two things: It rewards unnecessary care, and it reinforces the fragmentation that causes so much difficulty for patients and physicians.”
That fragmentation is what requires patients to physically carry medical records or X-rays from one doctor to another, for example, or results in tests having to be repeated because results can’t be found.
Spending May Not Be The Solution
As for rewarding unnecessary care, Fisher and his colleagues at Dartmouth have long studied how health care spending varies widely in different parts of the country. Their research suggests that more spending is definitely not better.
“The highest spending regions of the country and the highest spending health systems in the country have much bigger problems with care coordination and no better outcomes, and lower quality of care,” Fisher says.
Many experts have said that primary care doctors – most patients’ point of entry to the health care system – are underpaid. But Fisher says the real solution is not just to pay them more, but to pay them differently.
“Currently, physicians are paid only for each visit that they make,” he explains. “But they’re not paid at all for calling you up that evening to see if you’ve gotten better on the medications and could have avoided the hospital stay.”
And there are other, relatively easy fixes, says Holtz-Eakin.
“Reward prevention,” he offers. “There’s a lot of evidence that if we do the preventive care, you don’t end up with costly things down the road.”
Of course, when you’re talking about moving around hundreds of billions of dollars, even areas where there is broad agreement can get bogged down on the details. But there seems to be a growing consensus that fixing the health care delivery system would be a good place to start.
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