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Tuesday, September 8, 2009

Healthcare Reform

Thus far I've stayed out of the debate on healthcare reform, mostly because I'm a technology geek. But I'm also a taxpayer and a consumer, and therefore entitled to some opinions on the topic of reform. I'm not very well versed in all the issues, which makes this even harder to write about.

Thinking about healthcare interoperability, if I do my job right, the time needed for tasks that are currently performed manually will be greatly reduced. That means that effective interoperability will either put people out of work, or what I hope is more likely, allow them to spend their time on other tasks that don't get enough attention.

When I think about effective health reform, I see some of the same dynamics and this introduces some fairly large problems because the people that might be put out of work, or compensated at a reduced amount have some very strong lobbies. An effective health reform program will hopefully reduce both the need for and cost of services. My hope is that the costs and services it reduces are those dealing with the later stages of disease (because we don't need as many as a result of better care, not due to rationing), and non-essential administrative services.

A classic way to reduce non-essential administrative services is to deal with them at a large scale. We see this all the time in mergers and aquisitions, where most often, the hardest hit jobs are those that are non-revenue producing (HR, Administration, Finance). Our current system of payment is overripe for that sort of reduction in force.

One of the chief complaints about the public option is that it puts payers on an unfair footing, since the government can operate at an economy of scale that payers are not able to. If the Federal government can manage it and compete with the payers, I'm all for it. It may be an unfair footing, but from my perspective as a patient, I'm not terribly interested in being fair to anyone but patients and to some degree doctors. Frankly, I really don't understand what payers have done for me that couldn't be done better some other way.

Another aspect to look at is that payers should be able deal with those same economies of scale that the government does. Perhaps if they had the same opportunities that the Federal government had, they wouldn't complain so much.

This leads into the next issue, which involves the rights of the States. What makes for acceptable healthcare coverage, and who should define it? It's a national issue, but the States want their own say. If we were able to define an acceptable level of healthcare for all citizens of the US, and insurers were able offer the same level of service across the states, that would allow them to reduce there own costs. Unfortunately, unlike other countries, we don't have one national government that is really in charge of the problem, we have to deal with the states as well.

The scariest think about all of this is how complex this topic appears. The text of the current bills according to NPR this AM exceeded 1000 pages. I know healthcare is complicated, but do we really need 1000 pages to reform it. Makes me think I want to hire Jorge X. McKie to take away their word processors and give them a quill pen and two pieces of parchment. Even the ARRA was less than 500 pages, and the HITECH portion, a mere 50. A fount of brevity by comparison.

Quite honestly, I don't think the problem is that complex. The reality is that the real solutions are simply to harsh for our current system to accept. It's going to mean that we need to change over time, and what cannot be changed in this generation, will have to wait for the next one. That's why I like some of the discussions around setting a deadline. If we cannot resolve the problem under the current system by 2015, then we take more "drastic action". It's like in healthcare, where we look at different options for treatment, we go with the less invasive first, and if that fails, then we consider surgery.

Of course, in any plan of care, getting the patient to acknowledge that they have a disease is critical. Our current system of paying for care is diseased, and needs treatment.


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