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Politics & Current Affairs

Deconstructing the Health Care Debate

With the American health care debate in full force, Big Think thought it an opportune time to put together a package on the subject. Today we roll out two interviews with experts on the industry: Yale political science professor Jacob Hacker, whose 2007 proposal “Healthcare for America” launched the public option to national prominence, and George Halvorson, CEO of Kaiser Permanente and author of the new book, “Health Care Will Not Reform Itself: A User’s Guide to Refocusing and Reforming American Health Care.” In addition, we recently polled some of the industry’s recognized thought leaders to ascertain their vision of the ideal medical plan. Should the U.S. have one single system, or should we piece together a patchwork of systems? Should we embrace a public health care option? Interesting insights that came out of the survey are highlighted after the jump.

Jacob Hacker offers his opinion of the bill just passed by the House of Representatives and predicts its ultimate fate. He assesses the Democrats’ performance on the health care issue more generally, expressing satisfaction—but not surprise—at how much traction it’s gained this year. Finally, he offers a few words of advice for ordinary citizens who feel like helpless spectators amid the Washington bickering—even as their coverage depends on its outcome.

George Halvorson discusses the necessity of an information technology revolution. Kaiser Permanente’s transformation to electronic medical records has resulted in serious health benefits for patients. “We created care plans for all the patients with heart conditions and made sure that we delivered on the care plan so that it was a team of primary care doctor, cardiologist, pharmacists, nurses, receptionist — I mean a full care team relating to the patient, with care plans for each patient that we tracked through the computer, supported through the computer, and reminded people of the next thing to do through the computer.  And we cut the death rate from both major forms of heart disease by 73 percent in two years.”


*Our experts were split down the middle as to whether they wanted to see a new public plan created that provides coverage for a comprehensive set of benefits.

*They had some other ideas for how public programs should be amended:

     -The government should assure provision of mandatory, national-pool   catastrophic insurance for all.

     -Less fortunate people should be allowed to participate in the system through direct aid.

     -Medicare should be expanded to cover more of the chronically uninsured or uninsurable, but reimbursement to providers must be at an appropriate level.

*In terms of cost containment, our experts favored two ideas:

     -Simplify health insurance administration by adopting standards for transactions, including timely and transparent claims and denial management processes and use of standard electronic transactions.

     -Require insurers to adopt uniform billing and claims forms.

*They had some other innovative ideas for cost containment:

     – A “base-cutting” model: set up an independent expert Board to recommend quality best practices and control prices.

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     – Cap profits of insurers.

     -Self-referral and ownership of hospitals, outpatient surgery centers and other “self–referral” entities should be prohibited. -Corporate practice of medicine laws that prohibit hospitals from employing physicians should be eliminated.

     -Create instate value based purchasing to reward quality and utilization rather than inventing volume.

*When it came to quality control—how can we raise the standard of care?—our experts favored two proposals:

     -Encourage states to develop alternatives to the current civil litigation system as a way to improve patient safety, reduce medical errors, increase the availability of a prompt and fair resolution of disputes, and improve access to liability insurance, while preserving an individual’s right to seek redress in court.

     -Provide grants for improving health system efficiency, including grants to establish community health teams to support a medical home model, medication management services, regional emergency care and trauma systems.


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