Wednesday, March 10, 2010

To Your Health: Reform Breakthrough?

Day 22 of 46 c Lenten Season 2010

The story goes that last summer, Apple CEO Steve Jobs shopped around for the liver that saved his life - and we ain't talkin' about the chopped stuff. Jobs had withdrawn from the technology scene amid reports that his health was failing, and speculation only increased when the secretive Jobs and his savvy company refused to address the issue in the media.

Not that Jobs owed anybody but his family any information about his personal well-being. But all sorts of red flags shot up when it was finally revealed that he had undergone a liver transplant at Methodist University Hospital in Tennessee.

Jobs doesn’t live in Tennessee, so how did he get on a transplant list in Memphis? How did he manage to get to the head of the transplant line, when some people have to wait years? Did his enormous wealth give him a distinct advantage over ordinary folk who can’t play – or buy – the system?

Apparently, it’s perfectly legal to trot around the country and register for transplant lists in as many states and cities as you’d like. It's called "multiple listing." As long as you can afford all of the required testing, there’s no law preventing you from increasing the odds you’ll get picked sooner. Experts say the specific medical attributes of Jobs’ case would have been the major determinant for him moving past other people in line anyway - at least, in Memphis.

Certainly, nobody denies Jobs’ right to try and secure for himself the best medical attention he could afford. But what smacks so many people as wrong about this case is the “afford” part. How many average Americans can afford the process of registering for transplant waiting lists across the country? Should you even game the system like that? What about other people who have been waiting longer than you? Whose life is more important?

Something is Broken - But What?

Some people point to the financial privilege Jobs enjoys and conclude that money still buys better care in America. Which, in some ways, is true. People can purchase insurance coverage that will treat them like royalty, and that is their privilege. But this case wasn’t about a ritzy hospital room with Chagall’s on the wall; a person legally bought special access for something as basic as a liver.

And that’s why some people look to the government, saying the only way to ensure equal treatment for all is to have the government run healthcare.

Ladies and gentlemen, do you really think the government is so money-blind that preferential treatment won’t exist if Uncle Sam ran healthcare?

As I said yesterday, something is broken in terms of how medical components are funded and provided to the average patient. The actual procedure Jobs underwent probably didn’t cost any more than it would have done if the patient had been you or me. But money still played a role: the inability of other patients in Tennessee to do what Jobs did – travel around the country and register on other transplant waiting lists.

Isn’t it time we Americans take stock of how we view the subtle differences with which we allow our healthcare industry to treat patients? Is healthcare just another commodity that can be bought and sold based on one’s ability to pay? Could we actually lower the overall cost of care if we re-think how money flows in the system?

For example, in Jobs’ case, wouldn’t having a national network of transplant lists be more efficient, as well as more ethical?

My Big Idea

Of course, the immediate question is: who would run such a database? And my answer would be an independent organization I’ll call the Physician’s Standards Committee.

The Physician’s Standards Committee (PSC) would consist of directors who implement national policies as standards for delivering medical care in the United States. It would be the governing body responsible for ensuring that participating US citizens have relatively equal access to normative care. No hospital, pharmaceutical company, insurance company, or doctor would be allowed to practice or conduct business in the US without approval from the PSC. In some ways, it would be similar to the FDA, although the PSC would not test drugs; it would simply decide which drugs already approved by the FDA are the most effective.

Americans would join the PSC’s client roster through insurance companies, which would package policies for individuals or groups based on how they think they can make money. So far, this may sound eerily similar to proposals that have made the rounds in Washington. What makes my idea different is that the government doesn’t run the PSC. As a relatively autonomous unit, the PSC would (hopefully) be able to streamline healthcare delivery by enacting best-practices and protocols which would be what every insurance company, hospital, doctor, and patient use. It would kind of be like a non-bloated NASA – a group of the industry’s best and brightest but without the lobbying, politics, and delays from the federal government.

For example, in the Steve Jobs case, the PSC would already have established a national database for people waiting for transplants. Patients on this list would be judged by protocols set by the PSC, and whenever the right kidney match for Jobs – and everyone else on the list – came up, they would be notified. Similar procedures are already in place, but they're by geographic region only.

...In the Details...

Consider some other ideas of how it might work:

- There would be 50 PSC directors, medical professionals from a variety of specialties and backgrounds. Each director would be appointed by their state's governor. The general public would not vote for them, or have direct input in how they make their decisions. The general public could petition the directors, however. They could also petition the governor who appoints a director, and could vote out of office governors who appoint directors they don’t like.

- Directors would serve a term of three to four years, and then rotate back into their practice.

- Directors would evaluate processes and procedures, determine best practices, and maybe even make rulings on exceptional, critical cases. This way, insurance companies could develop transparent payment standards, but they wouldn’t need in-house review boards whose rulings could vary by company.

- Here’s a tricky part. The PSC would be funded from a combination of fees paid by member healthcare organizations and patients, as well as registration fees when new products are presented to PSC directors for consideration. Remember, since this isn't actually insurance, it won't cost billions of tax dollars. Even if some taxes did go so support the PSC, should one’s healthcare be a zero-sum proposition anyway?

- The directors would help control the costs of healthcare by evaluating services and providing a range that they, drawing upon their medical expertise, would consider equitable. Insurance companies, hospitals, pharmaceutical companies, and doctors would have to petition directors for any rate increases; they would have to follow their guidelines, and answer to them when problems arise.

- The directors would also help control pricing by instituting basic health and wellness initiatives that everyone wanting to purchase health insurance will have to follow. For example, if you smoke, overeat, over-drink, or otherwise intentionally compromise your health, insurance companies will be able to charge you more. If you don’t participate in wellness checkups, and even if you have too many automobile accidents, health insurance companies could raise their rates to cover you.

- Since it consists of acting medical professionals, the PSC would have a close pulse on the characteristics and changes in the evolving world of medicine and patient care, and could react much more swiftly when epidemics loom or other trends develop.


Of course, I don’t have space to fully explain this idea. And I realize that to some people, this could be interpreted as just another layer of bureaucracy. At the end of the day, maybe that’s all it is.

The goal with the PSC directors, though, is to prevent the oversight of America’s healthcare industry from falling into the federal government’s clutches, where it would easily ossify. Am I admitting that we need some national control over healthcare in our country? Yes, I guess I am. I’m not sure how the complex world of medicine and care delivery can be made cost-efficient without it.

Does my idea at least prove that alternatives exist to the plan Washington may soon vote on? What do you think?

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