Op-Ed, Sept. 2009

Health Care Reform

Daniel E. Evans, Jr. and D. Craig Brater, MD

The current congressional recess provides an important opportunity for constructive dialogue in the health care reform debate-an opportunity that must not be wasted.  The stakes are high, for the nation's health and its economy, so it's essential that Congress take the time to get reform right.

As leaders of Indiana's largest academic medical center and its only school of medicine, we have a big stake in seeing that the right kind of health care reform emerges from Congress in the months ahead.  We recognize that while the current U.S. health care system has several outstanding attributes, it also has many flaws.  Increasing the number of Americans with health insurance and reforming the nation's health care delivery system have the potential to improve the welfare of individuals, our local communities and our nation as a whole, while also creating a more financially sustainable system that will serve future generations.

To be successful in achieving the President's twin goals of expanding coverage while also "bending the health care cost curve," any solution must address the root causes of what ails our system today. 

We believe that the right kind of health care reform starts by re-aligning financial incentives for hospitals and physicians to reward the quality of care we provide as opposed to the quantity.  The current fee-for-service system pays providers based on the number of procedures performed and volume of services provided, rather than on patient outcomes or quality metrics.  The result is health care that is more expensive and less effective (or humane) than it could or should be.  We support a payment system that compensates us on the basis of value rather than volume, while taking into account the severity of the illnesses we treat.

Similarly, real reform will organize care around the patient rather than providers.  Physicians and other health workers should be encouraged to care for patients and not simply provide care to them. For example, we should promote efforts by primary care physicians to manage the care of chronically ill patients, ensuring that multiple specialists communicate with each other and coordinate their efforts to treat patients' multiple problems.  Medicare and other payers today do not encourage a coordinated care approach across different providers.  Patients too often see multiple specialists without any care coordination, putting them at risk of receiving multiple prescriptions or other treatments that are redundant or even harmful.

Real reform will expand access to care for the uninsured and under-insured in a way that does not explode the federal deficit and exacerbate the inefficiencies and cost shifting of today's system. Everyday, we see the consequences of a system that does not provide regular access to health care services for millions of people.  Therefore we strongly support efforts to provide insurance coverage to as many Americans as possible who currently lack it. 

 Real reform will also address the serious shortage of physicians, nurses, and other health care workers facing our country and state.  Our aging population, and increases in demand that will follow any expansion in health insurance coverage, will challenge our health care delivery system in the years ahead.  As a result, we strongly support efforts to expand the health care workforce and provide incentives to attract and train more primary care physicians, nurses, and other critical caregivers.

Finally, real reform will also include incentives for individuals to assume greater responsibility for their health and their health care decisions.  When the bulk of health care services are paid by third parties, either private insurers or public health programs, is it surprising that demand increases and costs soar?  We all have to acknowledge our role in managing health care costs by making more informed decisions about treatment options and by doing more to maintain our own health.

Getting the "incentives" right is critical to changing how any system such as health care functions over time.  If we want better quality and more efficient health care, we must reward the doctors and hospitals that provide it.  If, instead, we simply cut payments to all providers in order to reduce health care costs, the results will be terribly damaging to the health and well being of patients and communities across our state and our country.

In crafting health care reform legislation, Congress has a choice between real reforms that improve quality and slow cost growth, or incremental measures that simply extend the unsustainable status quo, leaving the inevitable and more difficult tasks to future generations.  We encourage our representatives to deliberate carefully and to support real reforms that our health system urgently needs. They may never cast a more important vote.