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Question: How should healthcare be reformed? 


David Katz: I think we need two parallel systems of reform right now. We need a disease care reform system. I think basic disease care access and basic access to health care is a human right. I think we should acknowledge it as such. Frankly, if we need a constitutional amendment to put it in the Bill of Rights, if that’s what it will take to prevent us from walking away from this challenge, then that’s what we ought to do. Nobody with a conscience would leave the victim of a shark attack to bleed while we figure out whether or not they could pay for care. That tells us that at some level, health care access is a basic human right. It should be codified as such. And our system should be aligned so that our policies match our morality. And then within that system where everybody has access, we need to incentivize prevention, both for the patient and the provider. There are a variety of ways to do this. I’ll cite just a few.

We have an organization called the United States Preventive Services Taskforce. It’s an independent group of experts who reviewed the literature and identified the evidence based practices in disease prevention that truly work. An example would be mammography. It really works to find breast cancer early and prevent the death that might otherwise result from it. Similarly, colonoscopy, which can actually prevent colon cancer outright because we can find polyps that are precancerous and remove them.

Vaccination. The pneumonia vaccine, the flu vaccine and the variety of immunizations for children of course are highly effective and highly cost effective. So we actually have this bible on clinical preventive services we know can save lives and in many instances dollars as well. Or frankly, we could incentivize the use of clinical preventive services for doctor and patient alike. If a patient is in compliance with recommended clinical preventive services for their age and sex group, we could perhaps waive their co-pays and deductibles. In other words, you could pay for the care you want by getting the care we know you need. It’s basically a link between rights and responsibilities. Yes, you have the right to healthcare access but you have the responsibility to use that access well. And one of the ways to use it well is to use those very procedures we know are most effective at saving lives and dollars. We could incentivize physicians; frankly in the same way by saying, this is really a partnership.

Patients are probably not going to have colonoscopy if you don’t address the issue, but even if you do they may say, “No, thanks anyway doc.” We'll incentivize both of you. Your reimbursement rates will be higher if a certain percentage of your patients are in compliance with recommended clinical preventive services. We can establish routine methods of doing chart review that look for evidence that you're monitoring weight and talking about it. That you're routinely addressing tobacco use, physical activity and diet and that you're using state of the art methods to address this topics. That's not rocket science. We can do that now and with the proliferation of electronic medical records it gets easier. If you are above a certain threshold, if you address this with a certain percentage of your patients, your reimbursements rates are higher, you'll get a bonus.


Recorded on: July 06, 2009



Article XXVIII: Universal H...

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