If one had to design a health care system that would seem doomed to failure one might start with one in which the providers of care were fragmented, independent and driven through the reimbursement system to provide ever more services that generate higher income on a fee for service basis. The system would provide care to patients who were isolated from the economic costs of the services by third party payments, through employer funded insurance coverage. Third party payers would make their money through reducing premium payouts, by simply delaying or not paying out what they contracted to provide or extorting deep provider discounts in exchange for directed volume. The approach to care of individual patients would be ad hoc, without significant oversight. Severely ill patients would be passed back and forth by all providers like the black queen of spades in a deck of cards. Bad debts would be written off as "charity care." Insurance premiums would rise faster than the world's oceans in global warming. Sound familiar?
Unfortunately, in an contentious and polarized political democracy little can be done to re-design an antiquated, inefficient, ineffective, and bankrupting cowboy system of health care delivery in a focused, comprehensive way that will likely make a real difference. There are just too many moving parts and special interests involved. There is, however, an incremental change underway as a result of the recent health care reform efforts that have the potential to morph the system into a paradigm that makes more practical sense. Medicare will be providing contracts with Accountable Care Organizations that will have to become clinically integrated systems of efficient hospitals and care providers in order to obtain adequate reimbursement. Expect to see these new systems expanding in the private sector as well.
Unfortunately, in an contentious and polarized political democracy little can be done to re-design an antiquated, inefficient, ineffective, and bankrupting cowboy system of health care delivery in a focused, comprehensive way that will likely make a real difference. There are just too many moving parts and special interests involved. There is, however, an incremental change underway as a result of the recent health care reform efforts that have the potential to morph the system into a paradigm that makes more practical sense. Medicare will be providing contracts with Accountable Care Organizations that will have to become clinically integrated systems of efficient hospitals and care providers in order to obtain adequate reimbursement. Expect to see these new systems expanding in the private sector as well.