Healthcare Reform – A Bottom Up Approach
What is the current debate?
As the discussion around healthcare reform has progressed in recent months, ideas (including cost containment and delivery system restructuring) have received support from both sides of the aisle. This makes sense, as these issues know no party, social status or level of income. Poor health affects us all – and the failure of our health system to properly prevent or diagnose and manage disease is the driving factor behind all healthcare reform issues. We need a healthcare system that not only treats us when we get sick but also helps us to manage our health and prevent disease through early detection and intervention. The center of attention in the current health reform discussion is the public plan option – and it is grabbing all the headlines. What should reform look like?
At the center of change has to be how health care is delivered and not who or how we pay for it. Until we consider changes in the current delivery system, it is safe to assume that health care will not be more affordable. Funding an enhanced primary care system with first dollar reimbursement, a focus on disease prevention, disease management and care coordination affords us the opportunity to control rising costs and helps us to truly reform the delivery system. There is no relationship between a person’s need for healthcare and their ability to pay.
For healthcare to be of measurable quality, affordable, and accessible it has to be flexible enough to address the needs of the working poor, the unemployed, the uninsured and uninsurable, for example, the diabetic, the hypertensive, the cancer patient, the epileptic, the mentally ill, the disabled, the aged and infirmed. It is impossible to have quality without accountability. The patient has to belong to a doctor and the doctor to a patient, wrapped in a network of care. As long as price is the arbiter of access, you can never have a quality standard because many people do not make logical decisions about their health and money. Parents sacrifice their health for their children, their spouses, their parents.
When we talk about prevention, I think we are talking as much about being proactive. Our current healthcare model focuses on a reactive hospital model. We allow problems to grow to a heightened level of need and then we throw everything at it. A proactive approach would implement a system to:
Strengthen the primary care network Insist that everybody has a primary care doctor Require that diagnosis and treatment defined by a protocol that has measurable outcomes be implemented.
What should we do?
Focus on primary care. We drive doctors away from primary care, lose our monitoring system, and waste our country’s wealth (GDP) on a broken system. Capitated primary healthcare utilizing a medical home model, feeds the primary care doctor’s fuel tank and creates an accountability system, between patient doctor and doctor hospital and doctor public health department that would revolutionize how we treat those in need and how we spend healthcare dollars. Re-examine employer-based healthcare. Employer based health insurance has failed us. It bankrupted General Motors, bankrupted the City of Columbia and forces unrelated to the nature of entrepreneurship and business manipulate its structure. Not only can the onset of a life threatening disease by an employee cause healthcare costs to rise for an entire company and its employees, but also the premature birth of an employee’s child, or the brain injury of a careless youth. What capriciousness created a system that makes unrelated people and businesses the victims of other unrelated people’s misfortune, carelessness or neglect? Why should a car dealer or a university, or a manufacturer have to worry about this? Insist that our government and legislators, town, city, county, state and nation re-examine the premise’s upon which our patchwork of healthcare systems are built and how the poor, minorities, and rural populations are disproportionately impacted by this broken system. Though there are real dangers of jumping from the frying pan into the fire, we must act; doing nothing is not an option.
Dean Slade is the Director of Grants and Planning at Eau Claire Cooperative Health Centers and has twenty years in healthcare. Ten years spent in managing a self-funded healthcare program for a Christian University and eight years working with Dr. Stuart Hamilton on helping design innovative healthcare models for providing access to low-income working poor. He is the designer of “The Plan” a comprehensive primary healthcare model with 350 members, partially funded by a grant from the United Way of the Midlands, which provides access to primary healthcare services for individuals and employers for an application fee of $20 and $25 per month. The model, embraced by the Cooperative’s physicians as a means to treat uncontrolled diabetics and hypertensives that must not use price as a determinant of seeking care, improves health outcomes.
