have done demonstrations to organize and coordinate how Medicare and Medicaid serve this population, the result has been higher quality care, better health status and HUGE savings for both programs.
4. Make living healthier lives a priority. Professor David Nash at Jefferson College has estimated that only 3% of Americans do the four simple things that matter most in living a healthy life: Dont smoke (weve made a lot of progress on this one, and it shows); eat a decent amount of fruits and vegetables; get some exercise (20 minutes, three times a week); and try to live somewhere near the normal weight for someone your height. According to Nash, if merely 10% of Americans could pull this off, the impact on healthcare costs would be giganticin the right direction.
We talked about many other issues during these discussions, too, some of which are on the national debate agenda, but most are not. These included:Cover everybody. (Surprise!) But on this one, the discussion focused more on having the federal government help pay for coverage expansions through Medicaid reimbursement expansionslike the Massachusetts health reform initiativerather than having the federal government do it.Do something about practice pattern variation. This one is a hot topic among the policy folks, but never gets into the public debate. Why? I suspect no one in politics wants to take on the notion that everything thats done in healthcare isnt necessary. But if you want to do anything about the cost of care, you have to wrestle with this topic.Squeeze the health insurance companies. OK, Ill be the first to admit that this one is a crowd pleaser, but ultimately squeezing the insurance companies saves pennies on the dollar. Most independent studies indicate that plan administration represents less than 10% of total healthcare spending, so reducing it by 2%-3% doesnt really solve the problem. Every penny helps, but no ones going to solve the healthcare cost crisis by simply taking it out on the plans. Theres not enough money there to support more than a few months worth of medical expense trend.Spend more federal research money on understanding how we apply the science we already know in the care delivery arena, and less on advancing basic science. If we really want to improve care delivery and enhance the cost and quality of the system overall, we have to start studying how and why we do what we do now, and the impact that has on outcomes. Advancing basic science without focusing on how we apply what we learn only answers half the question.Transparency. As the economy continues to sour, the pressure on employers to do something about the rising cost of healthcare will intensify. For employers, the choice will be between plan designs that have lower premiums and more consumer cost-sharing, or narrow network products that trade efficiencyand lower pricesfor broad network access. For either option to work over time, people will need far more information than they have available to them today on the cost and quality of healthcare providers.
All in all, I found a surprisingly large amount of common ground on what could be done. More importantly, a lot of the discussion was about improving quality and reducing the growth in medical expense trendboth of which can and should be priorities for President Barack Obama and Congress.
Charlie Baker is president and chief executive officer of Harvard Pilgrim Health Care, Wellesley, Mass.