Evaluating good health systems
I was a panelist for a talk yesterday at USC’s Keck School of Medicine. Panelists were Robin Podolsky of CA state senator Keuhl’s office (supporting a universal healthcare model), Glenn Melnick (Rand/USC Public Policy), and myself (market-based reform).
Some components I laid out in evaluating good future systems:
1) Separate “insurance” from chronic care and networks in addressing pain points: We bundle so many things under the headline of insurance that it confuses the issue. Remember that insurance is a mechanism to provide security in the face of uncontrollable, rare events. Obviously this is less effective when dealing with everyday health concerns or already-happened shifts into a chronic disease state
2) Is the system accountable/ responsive over time: Ensure that incentives are clear and transparent and that incentives link directly to good care (proxies are often well intended but create future confusion). Systems break when assumptions they are based on fail over time (e.g., people will die a certain number of years close to 65 when Medicare was enacted). How do we ensure that organizations not meeting societal needs over time fail?
3) Optimize for individual needs: Each plan should focus on allowing individuals to pick the features and providers that best meet their needs for any given concern. Much as people choose between McDonalds and the French Laundry using very different criteria, our plan designers shouldn’t impose top-down values on individuals who have different priorities. MinuteClinic is a great example…quick, basic care that turns the archetype of waiting for full-service medical care for simple ailments on its head…
4) Opportunity for innovation: Restricting degrees of freedom is often counterproductive in the long run. This is what frightens me most about legislative solutions…you end up with tax bills that look vastly different than proponents said they would (think Medicare or, more recently, Part D costs).
I did a quick check at ehealthinsurance to see what it would cost to get individual health insurance in NY vs. CA. NY has all kinds of regulations around what plans need to offer…and therefore has few available choices. Where the cheapest plan I could get cost $250 a month in NYC, my CA options started at $40 for an HSA plan…meaning that I could bank $210/mo into my HSA account. At the end of a year with a couple doctor appointments, I have over $2000 with which to pay for future pre-deductible care.
