OP-ED
October 2008
U.S. must engineer new prescription for broken health-care system
A person's DNA may someday determine how doctors diagnose illness and prescribe affordable treatment.
That same genetic makeup also might help doctors determine whether a person suffering from cancer might be predisposed to respond or not respond to chemotherapy or another type of innovative or experimental treatment.
That future picture of health-care delivery, however, is missing a key piece. It doesn't address what those advancements might mean for health insurance and other related questions about medical coverage. Our current health-care system just isn't robust enough to deliver present services, and much too cumbersome to handle these new services.
It's time to clean the slate and design a new system. Symptoms of this chronic problem are all around us.
Health-care spending has climbed at double-digit levels each year the past decade, with premiums surging 119 percent since 1999, vs. a 34 percent rise in workers' earnings in the same period. Forecasters say consumers will spend $1 of every $5 on health care annually by 2015.
One of every six Americans lives without health-care insurance. More than 46 million Americans will try to get through another day without health-care coverage, up 16 percent from 39.8 million in 1994.
Health-care providers report difficulty in recovering the costs they incur to provide health-care services and question whether they will be able to continue under current financing policies.
Corporations are concerned about being able to offer an affordable menu of health-care benefits to their employees and still compete in a global economy.
Our current fragmented and inefficient health-care system simply cannot keep up with growing costs and unmet public demand for care.
Yet for some unknown reason, polls indicate that health care has slipped from the No. 1 issue facing this country to barely in the top five. As we head toward the final weeks to elect a new president, don't be surprised if that moves toward the top of that list again before Election Day.
The 2005 report, titled "Health Care Reform: Why? What? When?" by Victor Fuchs and Ezekiel Emanuel, put the issue in perspective, stating that dissatisfaction with the U.S. health-care system is widespread but that no consensus has emerged as to how it can be reformed.
"The principal methods of finance - employer-based insurance, means-tested insurance and Medicare — are deeply and irreparably flawed," the report states. "Policymakers confront two fundamental questions: Should reform be incremental or comprehensive? And should priority be given to reforming the financing system or to improving organization and delivery?"
Perhaps all the above.
The largest payers for health care — the federal government and its state government cousin - must continue pressing for stronger incentives to drive higher quality, greater efficiency and the spread of best practices.
Further, we must embrace engineering tools and clinical information technologies for improving costs and efficiencies and reducing the number of "avoidable errors" that result in the death of an estimated 44,000 to 98,000 patients in U.S. hospitals each year.
Indiana is taking a major step to address patient safety issues, joining Minnesota as the only two states to implement a formal medical-error reporting system. Massachusetts and California are providing broader health coverage and introducing improved information technology, physician incentives and state and federal leadership to track our progress.
Those are starting points for a more comprehensive national strategy to address the ills of our health-care system, however. Leading providers, insurers, governments and the consumer must come to the table with a system-wide solution - and not their parochial interests - at the top of the agenda.
The need for reform becomes clearer every day.
Clearly, we know what works in America's health-care system: We can successfully treat our sick and nurse them back to health better and faster than any country in the world. But we must admit the health-care system is terminally ill and a new one must be designed.
Leroy B. Schwarz is the Louis A. Weil Jr. Professor of Management at Purdue University and a faculty scholar for the university's Regenstrief Center for Healthcare Engineering.
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