Europen and Asian leaders see an otherwise great country struggling to do what most of the developed world has already done – make basic healthcare a right
July 30, 2009 -- Why are we still not able to reform our healthcare system so all Americans have reasonable access to evidence-based prevention and public health measures and services that will actually improve our longevity, our health and our economy?
This summer I’ve been traveling to interview fellow Americans about their healthcare needs, what needs to change to transform our system and the obstacles to overcome if we are to genuinely improve healthcare outcomes and make healthcare affordable for all Americans.
These are some of the observations from these interviews:
The discussion and debate needs to be not just between Democrats vs. Republicans talking heads but all Americans.
We need less drama and rhetoric and more humility. Our healthcare access, growing uninsured and underinsured and medical-caused bankruptcy are seen as an ongoing tragedy to many healthcare leaders in Europe and Asia. They see an otherwise great country struggling to do what most of the developed world has already done – make basic healthcare a right without spending 1/6th of a nation’s gross domestic product or causing personal bankruptcies when citizens get really sick.
Americans are scared, skeptical and sobered about their jobs, the economy and have lost trust and faith in politicians and healthcare leaders who seem unable to reform and transform healthcare.
In California, Michigan and New York, I also sensed a new American resilience and hope. I witnessed people at Macomb Community College in Michigan agreeing with President Obama’s call for healthcare reform. I witnessed healthcare leaders, doctors and nurses demonstrate they know something must be done to use existing 21st century tools and to change how they are rewarded or discouraged from providing the right mix of healthcare in the right setting at the right time.
And, finally, we need a new Tim Russert to ask the hard questions and demand answers, and a new Walter Cronkite to provide the calm media leadership perspective to get us there.
Increasingly there is a slow but growing national concern that we simply must be changing some of the basics:
E-health – We have finally come to understand that we should be changing from fragmented and paper records to an electronic system of data and information that is built to improve a patient’s health rather than to maximize opportunities to increase a patient’s bill.
It’s the financial incentives stupid! We should be paying for healthcare and evidence-based prevention NOT by incenting the number of visits and procedures, but rather by incenting doctors, nurses and public health professionals to prevent, and, at the earliest practical time, detect diseases before that disease evolves. This delay in diagnosis and treatment combined with us paying unreasonable amounts for treatment is simply too expensive for Americans to tolerate any more.
A growing number of Americans have come to understand that we are actually spending more than any other developed country by not encouraging prevention and instead treating healthcare as a right only in an expensive emergency room setting.
Now that the dust has settled with our latest Oregon legislature which made some progress but still kicked too many cans down the road, what might some reporting by Cronkite and Russert suggest we do now?
Let’s agree that basic healthcare needs to be a right in preventive and primary care settings and not just in the hospital emergency room.
Let’s stop the bickering about what needs to change and instead at least build an Oregon patient-centered electronic health infrastructure so that in the next decade every Oregonian has a confidential, complete and accurate health and medical records that follows us at every preventive and diagnostic point of care. Instead of paper or even electronic silos, let’s have a patient-focused private and secure health record that integrates public health, school health, prevention, medical office and hospital information for providers and patients at the point of care.
Let’s insist that health payers and health insurance plans change their financial incentives to reward real evidence-based prevention and improved healthcare outcomes rather than overly rewarding the number of visits or procedures or duplicate tests we subject patients to.
By focusing on incenting and rewarding and paying for health outcomes, we can change the game. Let’s reward doctors, nurses and hospitals for making healthcare affordable and accessible.
Those are my thoughts. I look forward to hearing from people who are willing to challenge and improve my thoughts and make them actionable for Dr. Bruce Goldberg and the Oregon Health Authority, which are charged with reforming Oregon’s healthcare system.
Mike Leahy is currently an associate professor of health sciences at Linfield College and a clinical instructor in family medicine at Oregon Health & Science University. He was a leading healthcare executive for over 13 years with Kaiser Permanente in Portland and in the Bay area, a former public health director in Alameda County, California and Tillamook, Oregon, and the founding CEO of OCHIN in Portland.
Editor’s Note: In my previous role as the founder of Oregon Health Forum, I met Mike over 20 years ago when he was Kaiser’s VP/Health Plan Manager and chair of the Oregon Health Council which recommended the creation of the Health Services Commission and the Oregon Health Plan. – Diane Lund-Muzikant