Q&A in Health Care

Posted on | August 26, 2007 | Comments Off on Q&A in Health Care

It’s Time to Ask the Tough Questions

I recently spoke at the American Society of Association Executives meeting in Chicago and received these follow-up questions from Scott Litch Esq., CAE. I’ve posted his note and questions here with his permission, along with my answers.

From Scott: “I enjoyed Dr. Magee’s talk today at the American Society of Association Executives meeting in Chicago. Unfortunately there was not time for audience Q and A. I wanted to pose the following questions for Dr. Magee”:

Question 1: “Since the U.S. health care industry is heavily regulated now, and many problems (such as employer-based health care) have been created via government policies, why is it assumed by many advocates for health care reform that more government regulation, funding, and control of prices will really bring about efficient solutions?”

Answer: The health care debate today centers on two issues: equity and performance. The equity issue has been well reported, beginning with the WHO Report in 2000 that criticized the United States for high numbers of uninsured and high variability in delivery. The performance issue has been well documented, as well, beginning with Wennberg’s studies on variability and extending into discussions on quality and safety. Where do equity and performance intersect? They intersect in a truly preventive health care system focused on century-long lifespan planning, anticipation, behavioral change, multi-generational health and wellness, early diagnosis, and customized and personalized treatment plans with high adherence. In short, what we call health care today is so far off the mark that further tinkering with what we have will not likely get us where we need to be. To get there, we need a national plan that provides consistency, portability, compatible data bases, connectivity, 24/7 virtual access, continuous sharing and continuous learning. Piecemeal won’t do it. The starting point must be universal health insurance, baseline access to preventive services, targeted programs for those at greatest risk, and a uniform information system that links the people to the people caring for the people. Such an effort requires national leadership and national funding, but doesn’t preclude public/private partnering.

Question 2: “You suggested charging higher premiums for those who do not take care of themselves via preventive care, but would Americans view as “equitable” a health insurance plan for all where those who don’t stay healthy get charged higher premiums? That’s fine by me, but would an overweight person (Michael Moore comes to mind) be willing to accept this without squawking?”

Answer: Equity and justice are not inconsistent with fairness and personal responsibility. If we have a truly preventive system, accessible to all, and both efficient and effective, there must be rewards and consequences for individuals and families that do their earnest best to stay healthy (or not). That is reasonable. It is also true that there are those who find themselves at special risk — the poor, the disenfranchised, the undereducated, the unfortunate — who require our special support. The system needs to recognize that these individuals, families and communities exist, and target them, as needed, with special programs and special help. Fulfilling our potential as a nation to care for each other means that our best effort must be matched by each and every citizen’s best effort.

Question: 3: “How will preventive-oriented care succeed where prior efforts to ‘manage healthcare’ have failed? That is, even armed with plenty of information about health risks, millions and millions choose to drink excessively, smoke, not exercise, take illicit drugs, etc. Aren’t we up against some rather immovable forces of human nature?”

Answer: The intersection of aging demographics, health consumerism, the Internet and broadband connectivity, globalization and high speed travel and transport are hyper-accelerating a move toward health populism. This means that the people and the people caring for the people have restructured their relationship — moving from paternalism to partnerships, from individual to team approaches, and from intervention to information. In the past few years we’ve begun to see the information revolution in health morph into health activism and engagement. By this I mean that on the leading edge of health consumerism, individuals realize that information isn’t enough. We need to engage the system and change it fundamentally. Nearly a quarter of U.S. homes have an informal family caregiver in place. 85% are family members, and almost all of these are third-generation women (45 to 65), caring for parents and grandparents as they juggle children and grandchildren. Such complexity demands a health care system that is planning based, portable, virtual, accessible and efficient. In short, we need a system that makes sense. The problems and risks associated with changing our current system now exceed the problems and risks we might predict will be associated with attempting to transform it. And so, it is time to get on with it by engaging our best minds from all sectors of Society in the creation of a more enlightened, people centered, and home centered approach to health care. Properly supported, we will then be able to fairly measure our human nature’s capacity to appropriately respond.