Health Care Reform Made Simple

My name is John Ross and I have spent my entire 40 + year career in health care. Specifically, my background and experience is in developing and managing evidence planning, reimbursement applications, and health economics strategies for a number of fortune 500 health care technology businesses. In short, my job was to help the companies that I worked for to understand the health care market place from three important perspectives. The first was to answer the question; “What can we expect to be paid for the medical technologies we are developing and planning to market? The second question; “will the results and/or lower costs associated with the use of these medical technologies justify the payment level we think they deserve? Finally, what product development, marketing and sales strategies do we need to employ to insure that our future medical technologies are quickly accepted by hospitals, physicians, payers and patients? Obviously with such a focus I had to deal with Medicare (health insurance for folks over age 65 and the disabled), Medicaid (state-run insurance programs for the less fortunate) and commercial health insurance companies (the companies that insure and administer employer-based health insurance plans). I also spent a lot of time assessing the needs of physicians, hospitals and large integrated health care delivery networks that purchase and use a wide array of medical technologies.

From a funding standpoint I have seen America’s health care system go from almost “anything goes” to today’s increasing focus on cost and outcomes. Outcomes, is just another way of asking the question; “for the dollars we are spending nationally or on a particular patient’s disease or injury are we getting a good value in return? In other words, is the price of the drug, medical device, procedure, diagnostic or surgical intervention worth the cost in terms of better results and lower costs compared to how we would traditionally manage this patient’s condition?

This blog is a forum for talking “honestly” about:

1. Where health care in America is going?

2. Why it is going there?

3. What can we expect from tomorrow’s health care system compared to what we have become used to?

4. What we can do to the best of our ability to use less of it (think preventive health strategies)?

5. How we should think about and help those unfortunate individuals, young and old, who need more of it than we do?

6. How can we help to make sure those who need health care get access to good health care when they need it?

7. What can we do to increase the chances that state of the art health care will be there when we need it and at a price we can afford?

I will also provide education as to how the health care system works from the various perspectives of the stakeholders. It is vital that we understand these perspectives, what drives them and the many conflicts that exist. Areas to cover will be:

1. What is happening to hospitals and physicians in this changing health care landscape?

2. What is happening to the development of innovative future medical technologies and pharmaceuticals?

3. Where is Medicare policy going with regard to payments to physicians and hospitals and other care settings?

4. What is the future of employer-sponsored health insurance plans?

5. Where is changing with regard to private health care insurance companies?

6. What will happen to patient costs?

7. What can I do to avoid premature, unnecessary or unproven health care interventions?

8. What role will “evidence and data” play in the future in giving us more information from which to make personal or family member health care decisions?

I would like this to be the place that you can visit when you hear politicians or anyone else for that matter promising something from health care that just doesn’t make sense. We all know the feeling we get when we hear an “it’s too good to be true” story. When we hear such fantastic promises, we better check it out and this will be a place where you can do that. So, bring your concerns and questions and I will do my best to help you to check them out!

Have you heard this one; “under my health plan, you need not to worry. Your costs will remain reasonable, you can keep your doctor and you will have access to state of the art health care”. Or, “it is every ones right to access the very best in health care, young and old, rich and poor no matter your ability to pay.” This would be nice but it is simply not reality and it is time that we talk about these things and deal with them with our rose-colored glasses removed. So, no matter what your point of view on this subject I encourage you to visit ask and comment. We need a grass-roots effort aimed at understanding health care and in particular we need to talk about its funding limits and what we can do to assure that those who need it – get it, and at a level of quality and at a manageable cost such that we can afford it as a nation. If we don’t do this it is highly likely that health care as we have known it America will not be available when we face our own or a family members serious and costly illness.

The fundamental flaw in our individual approach to health care is the notion that we have no responsibility for it except to expect it to be there, with no delay, and at state of the art levels of care. And that for the most part it should be paid for by someone else. Most politicians right now are not leveling with us. They don’t want to address the areas that I have addressed even in this my first edition health care blog. Well, I think that we are better than that! I think with the right information we can manage through the changes that are coming. We want to do the right thing but to do so we have to be informed as to how stretched the health care system is and what we can do to unburden this precious resource.

First, we can stretch health care dollars and resources by taking better care of ourselves. The goal is to do what “we” can do in terms of learning about and practicing preventive disease strategies, thereby reducing the amount and cost of health care interventions we need. By behaving this way we free up our local health care systems funding and limited physical capacity to treat those who are truly in need. Every one of us that invests in preventive disease strategies will find that the beneficiary is you, your family, and your finances. Pretty tangible benefits wouldn’t you say? Perhaps bigger than that is what this behavior and better health for yourself and the avoidance of chronic diseases such as high blood pressure, heart disease, pulmonary (breathing) conditions, diabetes and a host of other conditions can do to unburden the nation’s health care system. We need to preserve it, both in terms of resources and dollars, for those who are less fortunate and have to access the system for serious health problems. How good would that feel?

Some would say that America is a scary place to be these days. The events of 9/11, the Iraq and Afghanistan wars, continued threats from terrorism, the housing and subsequent financial meltdowns, the political infighting that gets us nowhere, and yes the health care crisis. These all create the tendency to make us want to “wring our hands” instead of “wringing the necks of politicians” that refuse to provide the leadership that we need.

I have come to a conclusion. I have seen enough to know that the leadership we need has to come from us, the individuals who make up the electorate. Waiting around for politicians to act means we don’t understand the world of politics. Politicians only move in one direction or another when an exercised and voting electorate (that’s us) frames the issues and leads the way to a solution. It is almost never the other way around.

Bringing it back to health care and the question of what one individual can do to improve things, it starts with one individual and another until we have millions pulling in the same direction. If we manage our health to the best of our ability (and I want to emphasize, truly to the best of our ability) and access the health care system only when we need it, paying a little more out-of-pocket for the incidental and non-life threatening ills and spills we all experience, the system could accommodate us all when we really need it.

So there it is in a nut shell – I have spelled out what I believe is our responsibility; that if we all pulled in the same direction as described above (think of disease prevention and what this can do for you and those who do need to access the health care system) we would dramatically and permanently free up this precious and finite resource and it would be there for others in need and, when we need it and in most cases at far less cost. We are all in this together folks, rich and poor, the older among us and the younger and if we just act responsibly and for the good of others in this matter, we would solve the problem. And then, we could work on the next challenge and the next one after that until we see clearly the power of teamwork – “all for one and one for all”. That kind of thinking and behavior can work wonders. We all know it deep down – so let’s just do it!

Look for a weekly newsletter and articles that will deal with everything about health care in America. Look for weekly newsletters that discuss changes coming to employer sponsored health care benefits, changes coming to Medicare and Medicaid plans, new technologies that should be of interest, and articles and commentary with regard to state and national healthcare policies as they develop in the months and years to come. Any kind of question you have about health care I can help to point you to resources that will answer these questions. The specifics about your employer sponsored insurance plan, Medicare, Medicaid and how you can incorporate disease prevention strategies into your life with their big benefits. Ask away and if I don’t know or can’t find the answer, maybe one of this blogs participant’s will know. We are all in this together and as long as we believe that and look out for each other – everything will be alright!

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