Back of the Napkin Healthcare Policy: The HMRx 25/75 Solution to Reforming the American System
This is a blog post I've been meaning to write for a few months. You know what they say about the best laid plans...
Impetus to finally write it arrived while watching a replay of healthcare-related testimony before the Democratic National Committee on CSPAN2.
Unfortunately it's another sad rehash of problems with very few suggested solutions (although the next President's camp needs to hire farmer Ray McCormick from Vincennes, Indiana, as a policy advisor - his suggestions for improving access to care delivery and info include nifty, 'rogue' ideas like universal broadband availability).
When I think about where our healthcare system IS and IS GOING my stomach gets all swirly and twitchy. I'm certainly not alone.
82 percent of the American public believes US healthcare needs an overhaul.
From the Washington Post article above:
"There is a broad view by the public that our health care system needs a full overhaul, either to be totally rebuilt or reformed," said Cathy Schoen, senior vice president for research and evaluation at The Commonwealth Fund, which commissioned the survey.
Inevitably, when you get a bunch of healthcare types talking about 'saving' the system, the exchange is infused with passionate opinions about what healthcare in the US "should" be like.
We're still having trouble agreeing on the essential philo-social issue here: whether ALL healthcare in the US should be a right or a privilege.
The first thing to acknowledge is that if you're Medicare/Medicaid eligible, healthcare is absolutely a right. If you visit ANY ER in the US, regardless of citizenship (or lack thereof) your stabilizing care (and often much more due to the fear of legal action) is a right. In most other cases, healthcare is a privilege.
Problem is, once we get talking in these terms, the conversation devolves into universal platitudes that need a strong injection of reality.
"Everyone should have access to healthcare." Undoubtedly.
But access to WHAT healthcare?
What kinds of necessary, lifesaving services do we deserve by virtue of being US citizens (and/or residents or "visitors" - see EMTALA)? What discretionary services are a privilege we should pay for with supplemental insurance coverage?
Asking if US healthcare is a 'right or a privilege' is a tragic oversimplification of the issue.
It may be possible to structure a system that acknowledges certain kinds of lifesaving 'needs' are a right, while certain kinds of discretionary 'wants' are a privilege.
Another big problem in the policy renovation debate is based on the thickness of wallets.
Current players (insurance, pharma, hospitals, AMCs, etc.) have significant skin in the game.
The cooption of our current system by a 'universal' federally funded system will create a few big winners and many mammoth losers. Do you think the healthcare PACs will allow that to happen?!
A policy that has any chance of being successful (read: passing House, Senate, and Presidential approval) takes into account the significant infrastructure already in place, and considers the interests of those who will, ahem, support politicians who provide fertile ground for potential continued operations in a new system.
You'll see why I believe that's possible - preserving a place for many of our current players - in the photos above.
Those of you who have suffered through dinner (and after dinner, and breakfast) policy conversations with me have probably seen a simple version of the graph above.
Does the 25/75 Solution have any chance of saving American healthcare? Probably not.
But it provides a way to visualize the issue and get more people involved in the mindstorm. (Also notice I put EHRs under the 'necessary' 25% category...in the future, when costs come down, I'd place personal genetic sequencing here too).
More brains = greater potential for sparking debate that drives change and creates other, more effective potential reforms.
Perhaps we need a 60/40 Solution. May it's 50/50. Perhaps the plan is hopelessly naive. Probably the plan is hopelessly naive. Maybe we need a stronger structure that weeds out more current industry players.
Maybe this format won't work at all, but looking at the graph someone will suddenly be struck with divine inspiration and come up with something that will. Start talking about all the reasons why this wouldn't work - they'll lead you to thinking about what may be successful.
Click on the photos to enlarge the chart. Ask questions via comments. Someone send me a link for a simple design interface one step up from MSPaint so I can stop drawing this thing on Post-Its, napkins, and other paper products. Discuss.
And please, come up with something better. American healthcare deserves many more back of the napkin brainstorms.