Sunday, June 14, 2009

What Do We Need?

Still continuing with thoughts from Friday, Anthony McCarthy asked me to consider "what type of program would you build" before coming on the show.

From what I have discussed already, you can see that I can argue either side of whether we should have a single payer system. It is an open empirical question whether it would cost "less" to society to lose the choice of different financing options and possibly losing some treatment options or to gain the efficiency of having one set of rules and lower administrative costs.

However, the discussion does not end with the choice of financing. In fact, that is really only the beginning.

The second thing I would focus on is how the health care that is provided is organized. There was an interesting piece recently focused on variation in medical care practice around the country. One piece of the article was a discussion of ways of organizing care to get better outcomes at lower costs. The conclusion that was drawn that in care systems where one organization is responsible for all the care of an individual that usually promotes the kind of thinking that can lead to high quality efficient care. The key is that very few of the care systems in America have chosen to organize in this way. Could the government find ways to provide incentives for providers to organize care that way?

The third thing--in any system that ensures everyone (if we consider a mandate or consider health insurance as a right--which is different from considering health care or good health as a right since even those with health insurance doesn't guarantee access to care) there should be a combination of rights and responsibilities. While it is not always easy to establish what is a person's fault, some things (e.g. smoking) are obviously issues of choice and we should consider higher copayments or higher premiums for people with poor health that can be attributed to their behavior.

So, insure everyone, reorganize care, and provide incentives for people to be responsible. That would be my plan.

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