Former NBC Anchor Tom Brokaw and current Mayo Clinic Trustee opened the Mayo Clinic Health Policy Symposium with a brief keynote address. Then Helen Darling, from the National Business Group on Health, shared the perspective of employers. Here’s a sampling:
- Cost, Safety, Efficiency, Effectiveness and Access must be addressed simultaneously
- All hospitals must be made as safe as we can possibly make them. All serious adverse events must be reported and root cause analysis done to improve safety.
- The payment system must be drastically reformed to reward outcomes and pay for primary care and disease prevention. She says 2-5 percent of Medicare funding should be targeted
- Need to substantially increase funding for comparative analysis of treatments
- Build a national health information network with portable electronic medical records
Dennis Rivera of the SEIU shared the labor perspective. Rising medical costs seriously hinder the ability of unions to bargain for higher wages, because so much is being consumed by rising health premiums and co-pays. He listed these top priorities:
- Health reform must provide universal coverage
- Government and individuals must share in the financing of health care
- All Americans must be guaranteed their choice of doctors and health care plans, and we must
- Long-term care must be fully integrated into the health care system
Finally, Rivera said the perfect must not be allowed to be the enemy of the good. We can’t scuttle reform just because it isn’t quite what we as individual stakeholders want.
After these two speeches, a panel discussion ensued:
Jim Guest from Consumers Union summarized the perspective of Consumer Reports readers. You can read the series of articles from his magazine here.
Michael Porter said it’s clear we’re not getting full value for the dollars we’re spending, because the system is organized around the supply rather than the consumer. The solo doctor working alone won’t get us there. The problem isn’t the science, but the structure of how we are working together (or not) to provide care.
Gary Kaplan, M.D., from Virginia Mason Medical Center in Seattle, told his story of using the Toyota Production System to re-engineer their delivery system to eliminate waste and defects. They had been challenged by Aetna and Starbucks. Forward-thinking payers enabled them to do this by adjusting payments not penalize efficiency. This “value stream” analysis is an important element of fixing the system to truly get what we’re paying for, so we aren’t just automating bad processes, “moving garbage at the speed of light.”
Ian Morrison, Ph.D., says the problem is that the debate so far is more about getting people covered, instead of fixing a system that is broken. It’s not just “getting people a card” so they have access. Much deeper reform is needed. Unfortunately, most of the political speeches are focused solely on coverage instead of quality.
Guest said consumers need to be given the information so they can make informed decisions. He said those developing reform proposals need to put themselves in the patients’ shoes.
Dr. Kaplan said involving patients in their Virginia Mason Production System events has been crucial, because some of the best insights in reforming their processes come from patients.
Porter said improving quality is the best way to contain costs. For example, if patients quit taking their diabetes drugs because of co-pays, it ends up costing more in the long run. He has worked with the European countries that have already fixed the insurance problem, but they still have the delivery system problems. Here is an interesting article for further reading about Porter’s perspective.
Porter says single-payer vs. multiple-payer isn’t the real issue: it’s reforming the delivery system. We have hyper-fragmentation of care. Doing heart transplants at 139 hospitals doesn’t make sense; many of those don’t do enough transplants to become truly excellent. He says the model that tries to provide highly specialized care in every local facility may need to change.
Dr. Kaplan says there is enough money in the system to provide universal access if we take the waste out.
Dr. Morrison says there is no such thing as voluntary universal coverage. Health care is both a right and an obligation. Porter said a third of Massachusetts uninsured had incomes greater than $90,000. If we don’t require everyone to participate, but guarantee access to all, it won’t work. The “free riders” need to contribute.
You can watch the archived streaming video of this session here. Please weigh in with your thoughts in the comments below.
Update: The audio file from the panel discussion is here. Also here are the remarks from Helen Darling, Dennis Rivera, and Tom Brokaw.
