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Those of you who read my previous posts on health care reform know where I stand – that while its creators had the best of intentions, the bill ultimately failed to accomplish two key goals: increase quality and decrease costs. The most critical pieces that legislators missed include tort reform, competitive insurance across state lines and much more aggressive pay-for-performance measures and disease management-based incentives. With these additions, health care reform would have been viewed as much more cost-conscious and quality-focused. Instead, we’re now left with a “Frankenstein” system that was cobbled together with, in many ways, the best of the worst – one that’s expensive to maintain and challenging for physicians, providers and ultimately patients.
In a move that caught many by surprise, the recently-installed coalition government of Britain has proposed a radical reorganization of the National Health Service (NHS). The goals of the reorganization are to decentralize the control of the NHS budget, dismantle layers of bureaucracy, empower patients, and realize some £20 billion in savings through increased efficiency. All of this is set against a backdrop that calls for doing more with less – improving outcomes, ensuring high quality care and patient safety and giving providers and hospitals more autonomy while requiring more accountability. The UK, like much of Europe, is looking at ways to restructure budgets and social programs, in an attempt to reduce deficit spending and overall debt. And while the original goals of healthcare reform in the US included cost control, we on this side of the Atlantic did not take the courageous steps necessary to “bend the curve” on health care costs.
Meaningful use was a major focus of many presentations at the recent Picis Exchange User Conference in Miami, but it was the representation from hospitals in Europe (including World Cup finalists Spain and the Netherlands!) and the UK, that sparked some of the most interesting discussions. It made me realize that European hospitals have been working to achieve many of the same “meaningful use” criteria that have become such a huge focus here in the U.S. – but that they have been doing it for much longer than ARRA HITECH has been around. From coordination of care to improving quality measures, Europeans have been in the “meaningful mindset” for a long time.
I was traveling through Europe during the last week of the healthcare debate, leading up to the House of Representative’s vote to pass the Senate’s version of healthcare reform. I found it quite interesting that both the European press and the “word on the street” seemed to indicate that most Europeans believed that the U.S. was “finally” going to catch up to them – that America was finally going to provide universal healthcare to all of the people in the U.S. You should have seen the surprise on those faces after I informed them that even the most optimistic estimates would still leave over 10 million people without health insurance (to put it in a European context…more than the entire population of Greece, or Belgium, or Austria). It was obvious that the average European impression of American-style health reform was a movement towards their norm. They failed to understand that this was less about healthcare, and much more about politics and winning elections.
When President Obama set out to pass healthcare reform legislation, he stated two specific reasons why this was so important: universal access to health insurance and cost control. In fact, he often spoke of how the spiraling costs of healthcare in the US threatened the very viability of our economy. The President said that we could not sit idly by and watch healthcare costs grow to consume 20 percent of our GDP. It was the reason why companies like GM could not compete against their foreign counterparts. Well, when you look at the Congressional Budget Office’s (CBO) projected outcomes of the legislation and the subsequent reconciliation bill that were just signed into law, there will still be 12 to 14 million Americans without health insurance 10 years from now, and the growth in healthcare expenditures will reach more than 20 percent of the GDP in 2020.
