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| Thought Leaders: Medicine |
Reform Redux
Len M. Nichols
12/01/2006
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Reform of the health care system
will very likely be the top domestic issue in the 2008 presidential election.
The barometers of health system stress are worse than they were on Bill
Clinton’s inauguration day, when health care reform seemed inevitable.
Agreed, Clinton’s effort failed spectacularly. This time
around, however, even the wealthiest Americans are starting to see how reform
can benefit them. For one thing, money buys you far less quality than many
realize. In March, the New England
Journal of Medicine reported that Americans
with higher income receive good care only 57 percent of the time—not much more
often than those with the lowest incomes, who receive good care 53 percent of
the time. Though we spend at least twice as much per capita on health care as
our major trading partners, our systemwide performance is ranked 37th by the
World Health Organization.
Also, American CEOs are now energized to support health care
reform as long as cost-containment is a primary element of the program. Wal-Mart
CEO Lee Scott made his views on the issue clear in his August 1 interview with
Charlie Rose on PBS. "I think we’re getting to a tipping point where this
country is going to be willing to move on health care," Scott told Rose. "First
of all, business and labor are going to have to participate and probably play
even more of a leadership role than government . . . and then bring the
political side along with them.
"Isn’t is amazing," Scott continued, "that Wal-Mart sells a
package of toilet paper today in Spokane, Wash., and suppliers all know [it] the
next day . . . yet when I went for my physical, then had a body scan down the
hall, I had to fill out separate paperwork."
World Wellness Web
Reform this time should be about harnessing technology to
produce an information system containing electronic health records that can stay
up-to-date with one’s history and medications. Paper records in a file in your
doctor’s office in New York are not going to help a clinician across the country
(or even across town) make the right choices in a hurry.
Consider a story that appeared in the journal Health Affairs
last year (September/October 2005). A casino in Las Vegas was easily able to
find out that a certain unlucky, but optimistic, gambler had a bad credit
rating, and hence denied him credit. Upon hearing this, he passed out. He was
taken to a nearby emergency room, where the hospital personnel were unable to
verify what medications he was taking and inadvertently killed him.
A medical information system could not only contain personal
information, but also decision support tools—for example, short explanatory
videos—so that any physician could access state-of-the-art information about
complex diagnostic and treatment options. This system is coming in fits and
starts already, but it can become a reality much faster if government programs
such as Medicare and Medicaid were to require it of providers. There are
concerns about privacy, but I think it is fair to assume we are talking about
making personal medical information available only to providers, not posting it
on the Web.
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