It has become clear that a relentless storm of cost pressures is driving healthcare into true crisis. An unprecedented number of Americans will become uninsured soon. Others will face out-of-pocket costs that place care and drugs out of reach. The national impacts will be fearsome, resonating through the health system and the economy at large.
What is unclear is whether we can overcome our national paralysis, act to minimize the trauma and forge a better, sustainable system. Can we save American healthcare?
We believe we can and we will. The upside to the impending turmoil is that we're all in the same boat. Everyone -- patients, doctors, hospitals, suppliers, insurance companies and employers -- stands to suffer if we take on water. In the deluge, even the most intractable partisans and special interests will be galvanized around common-sense solutions.
During the past two decades, health costs rose at twice the rate of general inflation. Last year the economy grew 1.6% while insurance premiums rose 13%, eight times the inflation rate and the fastest growth in 12 years. This year, premiums have risen 15% to 23% across the board, 11 times general inflation. Small businesses received 30% to 75% increases.
The fallout won't be pretty. As costs spiral upward, insurance and care will become more inaccessible. Throughout the country, safety-net hospitals and clinics, already stressed, will be overwhelmed and some will collapse. People with serious medical conditions may not get adequate care. The inability to cope with medical bills, already the leading cause of personal bankruptcy, may skyrocket. The weakening of the healthcare industry, one-seventh of our economy, will reverberate through every other economic sector.
Crossing the threshold of affordability is undesirable for any commodity, but for a basic societal function it is potentially catastrophic. Unabated, health costs by the mid-century are projected to represent one-third of the U.S. economy and consume two-thirds of the federal budget. These figures seem unfathomable to the contemporary mind.
Some will assert that the answer is to let government manage and pay for healthcare. But that would only change how the money flows. It wouldn't address the deeper problem, which is how care is delivered and how cost is created. That's where we must intervene, and quickly.
Healthcare costs are uncontrollable because the results of healthcare?s processes are invisible. Outcomes and cost information are only sometimes captured, but they are rarely shared or made publicly available. Objective comparisons of procedures, doctors, hospitals, suppliers and insurance companies remain hard to find.
The core issue here is a lack of accountability at every level of the system. Healthcare is a sprawling, fragmented complex of competing and relatively independent interests. Until we hold each participant in the healthcare process -- yes, patients too -- accountable for decisions and choices, controlling cost will remain an elusive ideal.
A practical approach to healthcare reform would do what's expedient and best for all Americans. It would identify a healthcare vision that nearly everyone could agree with, bringing all stakeholders together around that vision. And it would develop an action plan that can create the political momentum for change, specify the details of change and independently evaluate the recommendations.
What might that vision look like? In our meetings, a spectrum of business and healthcare representatives, many of them adversaries, consistently agreed on the following ideas:
* The American health system should be adjusted rather than replaced, preserving what works and fixing what doesn't. We should acknowledge what's good and avoid the lure of different systems with unknown problems.
* Everyone in America should be assured coverage for basic health services, which still need to be defined. Associating dollars with each patient would help avert the collapse of our safety-net infrastructure (and the loss of the billions of dollars we've invested in it).
* Healthcare liability processes must be rebalanced, so patients' rights are protected without damaging the health system's viability.
* Compatible information technologies should be promoted, facilitating more complete patient information and more efficient and effective decisionmaking.
* We should encourage expanded use of scientifically-based care guidelines, to produce better, more consistent outcomes at lower cost.
* With safeguards for privacy and liability, cost and quality information should be available on procedures, services and products throughout the system. This would make meaningful analysis possible for purchasers and patients. It should also lead to more responsible use of healthcare services and more affordable cost arrangements for everyone involved.
These approaches are a beginning. Though the business principles are still in their infancy in healthcare, each has been long accepted within the rest of progressive enterprise.
It is the hallmark of an advanced society that it can address its most serious problems directly and in favor of the public rather than the private interest. American healthcare needs that American focus now. Our reward will be better, sustainable access to care for generations to come.
Patricia Salber, M.D, is a physician with Kaiser Permanente in California and an adviser to the Center for Practical Health Reform, Orange Park, Fla. Brian Klepper is the center's founder and director.