by Ronald E. Bachman, FSA, MAAA,President and CEO, Healthcare Visions
Regardless of party affiliation, the American people are angry with the policies and politics of Washington, D.C. The Tea Party movement has led the way by uniting the “silent majority,” giving renewed voice to American principles of limited government, personal responsibility, and self-reliance.
But being against something is always easier than knowing what ideas and initiatives to be for. The challenge for the Tea Party movement and others is to shift from irate to ideas. From success to significance. The Tea Party Patriots can remain a movement against selected policies or grow into a movement that promotes common principles and/or specific policies. It does not need to detail solutions. It can stand ready to choose among options and specific ideas from others.
However, a stronger political position would be to understand the possibilities and direct policymakers to take specific actions.
For example, polling indicates that the American public recognizes that there are problems with health and health care, but there is no national consensus on a common vision for going forward. It is now time to lay out basic principles, desired outcomes, and general legislative proposals to deal with real health reform. Reform can be accomplished if we first establish a common vision through citizen input, coalesce around shared values, promote American ingenuity, and value bipartisan debate.
Establishing Basic Principles
A uniquely American solution must be founded on basic American principles and values. Before any specific policies are promoted, the following basic principles are suggested for discussion and debate. Any health reform proposal including private coverage, Medicare, Medicaid, SCHIP, and other aspects of the current health system should be measured against these:
1. Market-based—The U.S. Congress and states should establish a supportive legal and regulatory environment that will allow a creative, open, competitive entrepreneurial market to develop the health insurance products and services that will meet the needs of every citizen. Significant legal and regulatory barriers must be brought down to establish the framework for real market-based solutions.
2. Increased competition—Competition in an open free market is the best solution to lower prices, better services, higher quality, greater convenience, and more choices. New legislation and regulation are critical to increasing competition among insurers, providers, agents, and other providers and vendors of care.
3. Maximize insurance, minimize third-party reimbursements—Third-party reimbursements foster an environment of entitlement and unlimited demand for health care services. A system based on personal responsibility minimizes third-party reimbursements by putting financial power in the hands of consumers. A comprehensive system allows everyone to have insurance coverage, regardless of their current or future health status.
4. Security for the sickest—No one can be left behind. Health insurance is about financial security when sickness or accidents strike. Solutions must help the sickest patients get the best care, treatment, and understanding of their condition through financial and information empowerment. Any system that works only for the young, healthy, and wealthy is destined for failure.
5. Behavioral change, not cost-shifting—Behavioral change includes wellness, prevention, early intervention, and compliance with proven care and treatments. It means providers delivering evidence and outcomes value-based care. It’s about encouraging personal involvement in altering health and health care purchasing behaviors.
6. Personal Responsibility—Personal responsibility means taking ownership for good and bad health and health care decisions. It cannot effectively occur without information and support tools for increasing self-reliance. Support programs include patient financial involvement with incentives for participation, rewards for compliance, and educational support for better personal health management.
7. Ownership—Ownership means control of the key decisions affecting coverage, choice of treatments, and selection of providers. Ownership means possession of financial assets, choice of how to spend personal funds, the right to information regarding one’s own health, and ownership of a personal health record.
8. Portability—Portability allows individuals to continue coverage regardless of employment status and/or job changes. Policies that do not rely on employer-based insurance should be encouraged and expanded. Health insurance should not be dependent upon a job or lost when one changes jobs.
9. “Wholistic Care” (Physical, Mental, Spiritual, and Social)—Health should be viewed as an individual’s dynamic state of well-being that includes physical, mental, social, and spiritual balance. A focus on health recognizes the potential to improve the status of an individual in need, regardless of the diagnosis or condition.
Achievable Outcomes
American ingenuity can solve any problem and achieve any goal. By creating supporting policies based upon the above principles, the positive outcomes will include the following:
1. Transformation to quality—Simple reform of the current health system will not work. With a common vision, a transformed system will emerge, one that builds on existing strengths and improves the policies and processes that do not work.
2. Empowerment of consumers/patients—Empowerment will come from financial and information sharing. Market-based systems engage consumers in meaningful ways to understand their options and the risks and rewards associated with choices. The individual has both rights and responsibilities when it comes to their health and health care.
3. Health care consumerism—Health care consumerism will develop by putting economic purchasing power, and decision-making, in the hands of individuals. It’s about supplying the information and decision support tools they need, along with financial incentives, rewards, and other benefits that encourage personal involvement in altering health and health care purchasing behaviors.
4. Reduction in costs and increased affordability—Affordability is not just the dollars paid as premiums. It will be achieved through health choices and behavior changes. We are generally used to individuals paying less if they are nonsmokers (or quit smoking). Similarly, health care and insurance costs can be more affordable for individuals if they maintain healthy metrics for blood pressure, cholesterol, and body mass index. Affordability can also be achieved by rewarding Americans with serious health conditions for adherence to disease management standards or compliance with good lifestyles, diet, and exercise standards that stabilize chronic and persistent conditions.
5. Increased access and choices—Choice means personal options for insurance coverage, care, treatment, providers, participation, lifestyle, wellness activities, disease/ condition support programs, service conveniences, and educational resources. A choice not to be covered by insurance should be allowed, but getting care (even emergency care) without participation in an available insurance pool will have potential treatment and financial consequences. Once a viable, robust market-based system exists, government-based programs of Medicare, Medicaid, and SCHIP should allow individual choice for transitions to market-based alternatives.
6. Elimination of diversity in outcomes—Whether it is social, racial, geographic, or other categories, the diversity of outcomes will be mitigated once the segmentation of the existing insurance system is eliminated and all Americans are covered in the same system, treated by providers who practice best standards of care, and empowered with the same information and decision support tools.
7. Expanded use of technology—Health, health care, and health insurance will get an infusion of technology to lower costs, improve efficiency and effectiveness of coverage, and appropriately identify and distribute information. Whether it is personal care devices, personal health records, electronic medical records, or e-prescribing, the world of health is lacking in adoption of new technologies. Encouraging American ingenuity will advance the use of health care technology to lower costs and improve health.
8. Movement to a culture of health—A culture of health focuses on wellness and prevention rather than on disease, sickness, and treatments. Health activities should measure and reward participation in wellness assessments, compliance with condition management programs (e.g. taking medications, diet, exercise, office visits), and maintenance of good health characteristics (e.g. blood pressure, cholesterol, nicotine use, body mass index).
The time is right for developing a consensus based on common principles and desired outcomes. The need is great. The foundation blocks are bipartisan collaboration, support at the federal level, reform at the state level, creative product development, and individuals’ involvement in their own health and health care, empowered financially with information and choices.
Ideas from the left, right, and middle will have to meet a common set of accepted principles. Only then can we have a rational discussion of ideas such as: tort reform, cross-state selling, expanded HSAs, high-risk pools, federal regulations, coverage mandates, consumer protections, state/federal responsibilities, national insurance, etc. The mission is clear—Insure all Americans in a market-based affordable comprehensive health and health care system. The questions are: Who will help? Who will hinder? And who is willing to give power to the people over their most precious asset—their health? Let the people speak; let the collaborations begin!
Ronald E. Bachman FSA, MAAA is president and CEO of Healthcare Visions, a thought leadership firm dedicated to advancing ideas and policy initiatives that are transforming the U.S. health care market. The major goals of Healthcare Visions are to advance consumer-based solutions to lower the number of uninsureds, improve mental health coverage, develop the concept of consumer-centric Medicare and Medicaid, and advance employer introductions of health care consumerism. Ron, who chairs the CDHC Solutions Editorial Advisory Board, can be contacted at ronbachman[at]healthcarevisions.net.