Today, the Senate begins the process of reconciling the two healthcare reform bills that have moved through the committee process. All told, there are five healthcare reform bills in Congress right now; the task ahead is to reconcile these proposals into one bill able to receive majority support in both the House and the Senate. It's not going to be easy, but it is essential. As we move into this critical stage, I'm asking my members of Congress to support a plan that includes the following reforms:
1. Evidence-based care. We need to end the current system whereby patients demand (and physicians provide) treatments and services that patients do not need. Evidence based medical care, where physicians recommend and supervise health treatments that have a proven track-record of success, a track-record established by the rigorous collection of scientific data, must be the foundation of our healthcare system.
2. Electronic record-keeping. In the Obama stimulus plan, there was a good deal of money made available to hospitals and physicians prepared to adopt electronic record-keeping. Good. Better would be the adoption of open-source VA system because it would permit coordination between physicians and hospitals nation-wide. And it's much less expensive. More facts about open-source record-keeping can be found here.
3. Ending fee-for-service reimbursement of physicians. Physicians get paid every time they perform a test. That creates an incentive to order more tests. I'm not suggesting that physicians order tests to make more money; I am suggesting that we shouldn't pay physicians on that basis. I'd prefer a salary system like the ones used so successfully at places like the Cleveland Clinic and the Mayo Clinic.
4. Compassionate and realistic end-of-life care. If we set aside the crazy debate about death panels, the fact of the matter is that Americans are not very good at planning for the end of our lives. We know it's inevitable and yet.......We must make a greater effort to understand what it is we want out of our final months of life and then lay out that plan with our families. In my mind, this has nothing to do with the financial costs of medicine and everything to do with the emotional costs of life. But the reality is that planning for the end of life may very well save people money, at least in terms of avoiding expensive, aggressive, and unnecessary treatment. It will certainly provide us with peace of mind.
5. An individual mandate accompanied by a sound public option. My real preference is for a universal care, single-payer system. But that is not going to happen in this round of reform. The next-best-thing is an individual mandate and a public option plan. An individual mandate will require every American to obtain healthcare insurance. This will improve the pool of insurance recipients, ensuring that more young, healthy people are paying into the system. Anyone should be able to buy into the public plan (a distinct help for small employers, who are currently drowning in health insurance costs) and it must be self-sufficient in terms of costs. That will allow the public option to compete with private insurers on an even field. At the same time, we must provide significant subsidies to assist low-income folks who will now be required to join the healthcare system.
I'm willing to start reforms incrementally, with the caveat that we immediately cover every child in this nation and that we move quickly to provide a reasonably-priced public-option to get uninsured people into the system at once. My not-so-secret hope is that a public option plan would prove a success that would transition us into a universal care single-payer system. Other reforms, like requiring evidence-based care and electronic record-keeping, could be used in a public option plan. I am confident that they would quickly prove their worth as cost-cutting reforms. The bottom line is that our current healthcare system isn't working. We must try something new. Now.