The NYSHealth Foundation (New York State) today hosted Alan Weil of the National Academy for State Health Policy to talk about health care reform strategies in the United States. I attended in the place of Chuck Bell, my colleague at Consumer Reports, because he was otherwise busy today. I hardly knew what to expect. I am just coming to realize how much Chuck knows about healthcare reform policy and how long he has been working in the field. He has history in this field since at least the 90s, and he has a lot of information, experience, and contacts.
He told me to find two people at the event. I walked in, greeted someone and told him where I worked, then he told me that he had worked closely with Chuck for a long time. Without my prompting, he then immediately introduced me to the two others I wanted to meet. As best I could tell everyone at the event was a participant in healthcare reform subculture – they were tall doctors, lawyers, advocates for foundations, or otherwise stakeholders who knew a certain language and could communicate breathlessly about the nuances of a highly complicated cultural phenomena.
The problem in the United States healthcare system is that, for various reasons, this system is consuming a large percentage of the country’s economic output and delivering poor health outcomes in comparison to similar countries’ healthcare systems. One of the reasons for this is that the US has less government and more corporate influence in healthcare, and another reason is that the US gives some regulatory authority to states in deciding their own healthcare policies. I am naming these reasons but do not want to suggest that they are fundamental or of most importance; they are just two reasons which were raised at this particular talk.
Weil listed five points for consideration in anyone’s plan for enacting healthcare reform. Those points as I understood them are as follows:
- Each state must evaluate where it is in healthcare delivery and decide where it wants to go.
- States will have a lot of difficulty in comparing healthcare reform plans, because each state is in a different starting point and will have a different target end point.
- As states enact their plans to get from where they are in reform to where they are going, they all want to gather accountability and success metrics. However, these metrics will be different for each state, and since there is limited historical precedent for this kind of thought, in lots of ways it will be difficult to conclusively judge the extent to which any state’s actions are successful for so long as the state is enacting change. Metrics are much easier to gather after action is completed, but people really want metrics and proof immediately while work is being done.
- States have limited ability to exactly reach their targets, and may have to improvise or change plans in the middle of reform. For this reason, Weil advocated that states decide what costs and sacrifices they are willing to pay instead of focusing on what they would like to achieve. After deciding the investment, states should do the best possible with the investment committed and continually adapt plans if that seems practical.
- Individuals, states, and the nation should guide their actions by explicitly stating how much reform everyone wants. A lot of organizations have stated that US healthcare costs 30-40% more than comparable and better healthcare in other places. One possible target is that the US seeks to reduce costs by this large amount to match other countries. Another possible target is that the US enact minor reform to reduce costs by 5% or so. The actions needed to achieve these goals are entirely different, and achieving a 5% decrease in cost is probably not a step on the path to achieving a major reduction in cost.
Weil mentioned the Choosing Wisely campaign on which I work as one initiative to enact change. He did not describe the campaign, so apparently he expected everyone in the room to be conscious of it, and it was a small surprise to me that this community which I was visiting but which was not previously known to me is so connected to my work. There must be implications for this.