Let's put some reform in health care reform

The energy and rhetoric is boundless, and increasing support for "change" seems pervasive across the land.

Unfortunately, the current debate and efforts centering on health care reform are hollow and recall the debacle of 1994 -- much sound and fury, but no real change.

The need for change is obvious. Our nation spends far too much and gets suboptimal health care outcomes. Our health status is uneven, relative to other developed nations, yet our expenditures lead the world by a huge margin. And perhaps most alarming, our costs continue to increase, out of proportion to any gain in health.

We need both a will to act and a real plan of action. Pouring astronomical amounts of new money -- whether it is $600 billion or $1 trillion -- into the existing system, even if that covers millions more people, will do little more than add to our debt, increase our frustration, and make future change even more difficult and expensive. It will perpetuate our inferior health care. Costs will not fall, and it is unlikely we will even slow the rate of their increase.

We must have a logical, deliberate plan of action. Here are some initial and necessary steps:

1. Unequivocally agree that every citizen should have access to the basic health services necessary for a reasonable life.

2. Define the medical services that are essential, and proven to be of value, for the realization of a healthy life. This will be challenging, but it is essential for success. We will never be able to fund a health system that is centered on unconstrained and non-scientifically based consumption, regardless of relative value. Yet that is what we have today.

We are suffering the economic effects of a system that allows people, generally spending someone else's money, to use whatever resources they want. And this is coupled with a reimbursement system that typically pays care providers for doing something, regardless of value or outcome, rather than focusing on the total health of the individual. We have developed a sickness focus rather than a health focus. Little wonder that costs are running away.

This can be changed. But it will be hard, and it will demand that all parties abandon some of their rhetoric and self-interest in order to advance the public good.

A good starting point would involve using the leadership of our nation's nonpartisan Institute of Medicine, along with the experiences of other successful health systems throughout the world, to define those basic and essential health services that would form the baseline benefits of a plan for all Americans.

3. Mandate that all people will have access to those essential health services, and fund them through both private and public methods. With the essential benefit plan in place, the system could allow for the purchasing of additional benefits, if so desired, from the competitive marketplace. But every person would have, as a starting point, guaranteed coverage for truly essential care.

4. Invest in the components of a health infrastructure (clinics, personnel, outreach programs, etc.) needed to assure that services exist where people live.

Similarly, we should invest in and pay for approaches that help us take care to the individual -- something akin to house calls, either in person or by means of technology. This would be particularly valuable for those with chronic illness trying to live at home, or people living in forgotten parts of our larger cities and rural locations.

Of course, there is more to it than these initial steps. We need to change our reimbursement structure. We must shift to a system that pays care providers for taking care of the individual rather than for each event and intervention, regardless of value or result.

It is essential that we develop better approaches to educating our people on disease prevention and appropriate health interventions. But first we need a framework. This is not a call for a nationalized health system. In fact, it is an effort to avoid one, by intelligently and appropriately using our great health resources for all of our people.

Every nation is struggling with the costs of and outcomes from their health care systems. Yet many have realized great success, and from them we can learn much.

For example, in the Netherlands a mandatory set of essential health benefits is now provided to all people through private insurers, with financial support by the government for those who are unable to pay even the relatively low cost of the basic program. Beyond the essential benefit set, individuals and employers can buy supplemental coverage of their choosing (and at their expense).

There is no reason we cannot be equally forward-thinking, nor is there any excuse for allowing our current state of affairs to exist any longer.

If such an approach were used in our country, we could retain the participation of private insurance companies, but in a different, less intrusive and less costly role. We would foster competitive markets and ensure that basic health needs are met. And we would leave the option for people and companies to purchase additional services with their own funds. Per capita costs could be a fraction of what they are today, with even better outcomes.

Our reform efforts should not be about advocating a liberal or conservative approach, or the ideology of public or private enterprise, or for-profit vs. not-for-profit business models.

This is about realizing an undeniable end goal -- the health and well-being of each of our citizens. It is the path that any enlightened society must follow.

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William W. McGuire, M.D., is the retired chairman and CEO of the Minnetonka-based UnitedHealth Group.

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