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The case for reform of our health care system

In this election year, opinions are sharp and contrasting when it comes to the subject of health care reform and government’s role in the effort. Regardless of where you align politically, it’s hard to dispute that the U.S. health care system is in need of dramatic change.
The United States has the most costly health care system in the world, according to the World Health Organization, spending nearly one in five dollars of our economy on health care. While spending nearly twice that of other Western countries on health care, the U.S. ranks only 37th in terms of overall quality and performance-well below countries such as Malta, Oman and Andorra.
Today, U.S. health care debt is the No. 1 reason for personal bankruptcy. It is estimated that approximately $750 billion is squandered yearly on unnecessary medical care, fraud and other waste-30 percent of total annual U.S. health care expenditures.
This model of pay more, expect less is unacceptable and unsustainable, especially as employers and consumers increasingly shoulder more of the health care cost burden.
As one of the wealthiest, most developed nations in the world, with access to the top physicians and state-of-the-art medical technology, equipment and facilities, we can and should expect more-with respect to health care quality, patient safety, accessibility and value. While not a perfect solution, this is the intent of health care reform occurring nationally-and at the state level with Medicaid. And each of us, including doctors, hospitals, consumers, employers, pharmaceutical companies and insurance providers, plays an important role in helping the U.S. health care system meet this expectation.
To fix this complex problem, it’s important to understand how we got here. Unlike most retail goods and services, on which the provider and consumer have direct involvement in pricing and payment, the reimbursement model for health care has largely been shaped by health insurance, the primary payer of services. As a result, most consumers and providers have been insulated from the true cost of health care. Traditionally, employers covered the majority of cost for a family’s health care coverage, with no real incentive for consumers or providers to be concerned if procedures were medically necessary-or even affordable, since the consumer wasn’t paying the bill.
Consider if this scenario were applied to the auto industry. What if every covered member could get any model car for a $250 co-payment and the car dealer was guaranteed the rest of the payment from another party? What’s the incentive for either the salesperson or the customer to choose a cost-effective model that meets the need for transportation? There is none. And how does the third party maintain affordable coverage levels when it is increasingly paying for excessive and perhaps unnecessary purchases? It can’t.
This is the crisis we face today with U.S. health care. Hundreds of billions of dollars is wasted on inflated prices, fraud, unnecessary procedures and high-cost care for health conditions that are largely preventable-with little incentive for coordination and accountability of patient care. As a result, dramatic cost increases are being shifted to employers and consumers, while the overall health of America continues to decline.
What’s the solution? At the heart of health care reform is the premise of shared accountability. We must all take control of both the quality and cost of health care. As consumers, we must improve lifestyle habits that will help minimize costly, yet preventable conditions like heart disease and diabetes. We must also regularly question the necessity of tests and procedures, compare medical options, and ask our doctors and specialists to share lab and test results.
Health care providers, including hospitals and physicians, must be more transparent with patients about the medical need and true cost for recommended care prior to rendering the services-and must be vigilant about doing everything possible to deliver the safest, highest-quality care and customer service to each and every patient served.
Insurance providers must establish incentives to move the health care payment model from a fee-for-service reimbursement system, which rewards quantity of procedures, to one that truly rewards outstanding clinical performance and the management and coordination of patient care that ultimately results in better health.
Health care reform gives us the framework to begin to attack this monumental problem in a way that can create sustainable, long-term solutions. While we may disagree on the methods, the goal is indisputable and one we must address as a nation.
Mark C. Clement is Rochester General Health System president and CEO. This is the first of four articles examining health care reform that will appear over the next several months.

10/26/12 (c) 2012 Rochester Business Journal. To obtain permission to reprint this article, call 585-546-8303 or email rbj@rbj.net.


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