US Healthcare and Reform

Ok, enough is enough. After years of arguing for the private sector marketplace to reform itself, with all manner of managed care, managed competition, disease management, care management, cost management, consumer directed health management, patient-centered medical home management, chronic care management, Medicare Coordinated Care Demonstration, Medicare Health Support, and many other in which I have personally been involved, I give in. I give in to those who show our medical costs and health premiums are growing faster than our wages.













I give in to the fact that our Medicare and Medicaid program costs are mushrooming.











I admit you only get the "best" evidence-based care about half the time you see a physician. In other words, seeing a physician has many benefits, but expecting a physician to know everything there is to know all the time, well, it only happens about half the time.
I have seen the journal article by Dr. Steve Jencks, showing the inverse relationship between the amount you pay for care and the quality of the care you receive.

And the fact that the number of uninsured, although dropping in 2007 (the latest government data) is still quite high. Although people who are uninsured can get medical care, the amount of cost shifting it takes to fund uncompensated care and the inequity in charging an uninsured person more than the actual cost of care, makes you pause and think there has to be a better way.

Tipping Points

There are three "tipping points" in play that will combine to reform and revolutionize healthcare. The first is the economy. With every 1 percent increase in the unemployed in the United States, there are 1 million new Medicaid eligible persons and 1.1 million uninsured persons. This alone would start the engines rolling on serious health care reform discussions. The fact that the Democrats, traditionally in favor of government instigated health care reform, are in control of both the Executive and Congressional branches of government makes consideration of health care reform inevitable. This past week we saw continued negotiations between Congress and the Administration over the process for healthcare reform this year (which, by the way, tracks the November 17, 2008 predictions of this blog for healthcare reform to happen this year).

But the third impetus for reform is disruptive, and at the heart of American innovation and ingenuity. As we saw this past week, Walmart announced it is entering the electronic medical record market. This is the latest of several Walmart efforts to disrupt healthcare, including low-cost drugs and offering health coverage to most employees. But look for innovations to come from other players, including CVS/Caremark and Walgreens.

With everything that is happening, we will see health reform happen one way or another. Either through government fiat, or private sector disruption - and perhaps both.