Practical actions toward reforms
By Aaron Fausz, Ph.D., and
W. Terry Howell, Ed.D.
1. Price Transparency.
Continue to demand transparency of prices and quality of care in all aspects of healthcare, i.e. hospitals, clinics, etc. This will expose the huge, unnecessary variation in prices for the same procedures, and will enable customers to shop for low cost, high-quality health care like we do for everything else!
2. Allow Health Insurance to be Sold Across State Lines. Eliminate restrictions on insurance portability across state lines. Consumers should be able to go online and choose policies offered by large numbers of insurance companies with a wide variety of plans. This will allow consumers to purchase exactly what they need with nothing extra (just like they can do for their homeowners, auto, life and other types of insurance not provided by employers).
3. Expand Health Savings Accounts. Do everything possible to encourage consumers to become shoppers. Expand Health Saving Accounts for all, including after retirement. Encourage employers to move from a defined healthcare benefits model to a defined healthcare contribution model. This, combined with the previous recommendations, will allow employees to seek and receive only the care they need. We see this as a transition to the next step which is to disconnect health insurance from employment just like other types of insurance.
4. Disconnect Health Insurance from Employment. Eliminate tax incentives for employers to provide health insurance for their employees. The onus for purchasing health insurance should be on the individual, who should be incented to keep themselves healthy and to shop around for the best health insurance deal. Further, health insurance should only cover catastrophic health needs (not everyday things) in the same way our homeowners and automobile insurance policies cover only major events.
Combined with price transparency, the costs for routine health services will plummet when everyone is forced to pay their own way and providers are forced to compete for consumers’ business.
5. Teach that Healthcare = Medical Care + Self Care. Begin a nationwide campaign to educate consumers that healthcare= self-care + medical care. There is an epidemic of chronic disease in this country caused by four behaviors: excessive drinking, smoking, eating too much sugar and refined carbohydrates, and failing to exercise. These behaviors lead directly to hypertension (high blood pressure), heart disease, lung disease, and type two diabetes, which account for 70% of total healthcare dollars spent.
Because many people don’t attend to the self-care part of the healthcare equation, too many end up with one or more of these chronic diseases. They then expect the medical community to ‘fix’ their problem with pills or surgery. The medical community is ill-equipped to deal with this epidemic, which requires lifestyle changes that a 15-minute visit to the doctor cannot bring about.
6. Move Medical Care to the Appropriate Skill Level. Simplify credentialing and remove outmoded scope-of-practice limits on qualified nurse practitioners and physician assistants. In other words, the government should eliminate archaic obstacles to competition among medical providers. This will help the industry move work to the appropriate skill level, thereby reducing cost as well as the need for as many physicians. Physicians readily admit they are often working at the lower end of their skill set by performing tasks that others with less training could do just as well. Collectively across the country, this amounts to huge waste in the system.
7. Make Teaching Self Care a Priority in Schools. Instruct and inspire children to take control of their health maintenance through intensified instruction on nutrition, exercise, stress management, and the negative effects of not taking care of yourself. Bring in healthy role models (athletes, health coaches, physicians, etc.) to teach and inspire children to take control of their health.
8. Encourage Control of Medical Costs and Quality at the State Level. Move Medicaid dollars to the States to manage as they see fit, but encourage them to use the dollars to address the social determinates of care (such as housing, food security, job training, and placement). They should insist on transparency, reduce pharmacy costs, use Centers of Excellence for expensive surgeries, and send patients to local providers that are willing to go “at-risk” to provide primary care.
The federal government should insist on quality, safety and patient satisfaction data being tracked and going up, while healthcare costs are going down due to strategies to get and keep people healthy.
9. Reign in Big Pharma. Enable and encourage patients to purchase FDA approved drugs from anywhere in the world. Other countries are just as concerned as ours regarding the quality of drugs, and for a variety of reasons their costs are much cheaper. Don’t let Big Pharma in the U.S get away with saying they have to charge U.S. so much more because we are the only country that does the research and development. This is simply not true. Also, Medicare should be allowed to negotiate drug prices with pharmaceutical companies. Currently, it cannot. We need to quit requiring U.S. citizens to subsidize Big Pharma!
10. Take on the Food Industry. Force the food industry to quit filling everything with sugar and other refined carbohydrates and to quit lying to the public about which foods are healthy and which are not. The government should also end Food Stamp subsidies for unhealthy foods and encourage healthier food choices.
AARON FAUSZ holds a PhD in industrial and organizational psychology from the University of Tennessee in Knoxville, with a minor in industrial engineering. In addition to this book, he is coauthor of Leading Healthcare Improvement: A Personal and Organizational Journey.
Dr. Fausz has helped numerous organizations align and improve their personnel and business systems to accomplish strategic objectives. He has consulted with leading healthcare organizations across the country, including Denver Health, Henry Ford Health System, Kaiser Permanente, Mayo Clinic Health System, University Health Services, University of Texas Medical Branch, Vanderbilt University Medical Center, and many others.
W. TERRY HOWELL, Ed.D. has a doctorate in counseling psychology from the University of Tennessee and postdoctoral work in organizational development at Vanderbilt. He just recently started Skye Solutions, LLC focusing primarily on disruptive innovations in healthcare.
Dr, Howell’s consulting and executive coaching clients over the years have included a wide range of hospitals and hospital systems: Sloan Kettering, Yale–New Haven, Vanderbilt Adult Hospital, George Washington University Health System, Henry Ford Healthcare System, Denver Healthcare, St. Jude Children’s Research Center, Hospital Corporation of America, Kaiser Permanente, and Dartmouth-Hitchcock Medical Center, among others.
© 2020 Richfield Press. All rights reserved Reprinted with permission.