Stanley Feld M.D.,FACP,MACE
I am a big fan of Peter Senge’s “The Fifth Disciple”. President Obama’s healthcare reform bill is not solving the underlying systemic problems in the healthcare system. It may bring him fame and glory in the short term. It will be a financial disaster in the long term as many entitlement programs have been.
Peter Senge’s wrote (page 61);
“ The long term, most insidious consequence of applying non-systemic solutions is increase need for more and more of the solution.
This is why ill-conceived government interventions are not just ineffective, they are “addictive” in the sense of fostering increased dependency and lessened abilities of local people to solve their own problems.
The phenomenon of short term improvement leading to long term dependency is so common, it has its own mane among systems thinkers- it’s called “Shifting the Burden to the Intervenor.”
The intervenor may be federal assistance to cities, food relief agencies, or welfare program.
All “help” a host system, only to leave the system fundamentally weaker than before and more in need of further help.
Please consider Peter Senge’s concept as it relates to President Obama’s healthcare reform bill. His bill ignores or proposes the wrong solutions to the five most important systemic dysfunctions in the healthcare system.
The five most important systemic dysfunctions are:
Effective malpractice reform would correct this problem
The partial cost of defensive medicine extrapolating the Massachusetts Medical Society survey is at least $75 billion dollars a year. If extrapolated to all medical specialties the cost is in the range of $300 billion dollars a year. The cost excludes time wasted and the stress to both the physicians and patients.
Real healthcare insurance reform is needed as described previously. The ideal medical savings accounts, as opposed to health savings accounts or the present healthcare insurance product would eliminate bureaucratic ineffiency and put consumers in control of their healthcare dollars.
Patients must be incentivized to conserve their healthcare dollars and be responsible for maintaining their own health and well being
The elimination of the abuse and waste by the healthcare insurance industry is necessary. This can be achieved by effective accounting regulation reform for reporting Medical Loss ratios. The Medical Loss ratio accounting abuse adds little value to patient care.
At the same time the regulations for the healthcare insurance industry exemption from antitrust laws should be eliminated.
The elimination of administrative waste and paper work in physicians’ offices by creating a completely functional and effective electronic medical record in the “cloud” is needed.
The installation, updating and use of the ideal electronic medical record should be simple, customizable and inexpensive. The electronic medical record should t fit the physician’s work flow. Physicians should be charged by the click.
Physicians should not be expected to make large capital expenditures for electronic medical record systems that might not be totally functional and then be financially responsible for upgrading to improve functionality.
President Obama’s proposed system for implementing the electronic medical record will only delay adoption and functionality needed to reduce the cost of healthcare.
Systematic educational programs for patient self care and management of chronic diseases must be developed for all physicians. These chronic diseases include diabetes mellitus, chronic lung disease, asthma, hypertension, coronary artery disease, certain gastrointestinal diseases, osteoporosis, and arthritis.
Internet information sources can be constructed within physicians’ ideal electronic medical record. The information sources can be customized to the physicians’ office to educate patients. It must be constructed as an extension of a physician’s care. All of the instructional information is presently on the web. The trick is for physicians to pick appropriate sites with information that will be an extension of the physician’s care. Physicians have to have incentive to do this easily.
Along with cancer the complications of these chronic diseases consume 80% of the healthcare dollars paid to hospitals and physicians. The complications of these chronic diseases can be decreased by 50% is systems of self-management are developed. If the costly complications of these chronic diseases decrease healthcare spending can decrease by at least 50%.
If healthcare reform concentrated on these five areas, with a minimum increase in governmental bureaucratic agencies, America would be well on the way to placing control of the healthcare system in consumers’ hands. Consumers would have the incentives and freedom to choose. Consumer driven healthcare would force hospitals and physicians to either shape up or perish.
Government should make the rules, then get out of the way. Consumers must be empowered choose and be responsible for their own care. Consumers will drive the medical costs down.
Consumers have shown, in many areas of our economy, that they have the power to make efficient and wise decisions. We have only to look at the auto industry, the supermarket industry, the telecommunication industry, and the airline industry to realize that consumers are not dumb.
The government can make effective rules for the healthcare industry and let the consumer drive the healthcare system.
The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.
First, thank you for taking the effort to analyze an important problem and develop a forum where people can learn and think.
What do you think about this idea? Along with clear, transparent pricing, have health-care providers carry "cost-overrun" insurance. In essence, hospitals would set flat prices for procedures but would have any 'unexpected' costs covered by their insurance policy. Then, make the premiums that hospitals pay to cover their services available to consumers. The premiums would give consumers more information to help them make better decisions and reward the best hospitals. Hospitals would also end up paying for their own inefficiencies.
I know there other things we can do first to help drive down costs, such as tort reform. And I know there are complications with my idea; there are few "typical" patients or procedures, and care for chronic illness is very difficult to price. Also, insurance premiums are an imperfect measurement.
I just had this idea and haven't found anyone to run it by that might have some insight. Be gentle, I'm still a naive twenty-something.
And feel free to ignore my message. I don't want you to waste your time. I'll take a non-response as a direction to 'keep trying."
Posted by: Brett | February 04, 2010 at 03:18 PM