Health care reform made simple

Health Care Reform Made Simple

My name is John Ross and I have spent my entire 40 + year career in health care. Specifically, my background and experience is in developing and managing evidence planning, reimbursement applications, and health economics strategies for a number of fortune 500 health care technology businesses. In short, my job was to help the companies that I worked for to understand the health care market place from three important perspectives. The first was to answer the question; "What can we expect to be paid for the medical technologies we are developing and planning to market? The second question; "will the results and/or lower costs associated with the use of these medical technologies justify the payment level we think they deserve? Finally, what product development, marketing and sales strategies do we need to employ to insure that our future medical technologies are quickly accepted by hospitals, physicians, payers and patients? Obviously with such a focus I had to deal with Medicare (health insurance for folks over age 65 and the disabled), Medicaid (state-run insurance programs for the less fortunate) and commercial health insurance companies (the companies that insure and administer employer-based health insurance plans). I also spent a lot of time assessing the needs of physicians, hospitals and large integrated health care delivery networks that purchase and use a wide array of medical technologies.

From a funding standpoint I have seen America's health care system go from almost "anything goes" to today's increasing focus on cost and outcomes. Outcomes, is just another way of asking the question; "for the dollars we are spending nationally or on a particular patient's disease or injury are we getting a good value in return? In other words, is the price of the drug, medical device, procedure, diagnostic or surgical intervention worth the cost in terms of better results and lower costs compared to how we would traditionally manage this patient's condition?

This blog is a forum for talking "honestly" about:

1. Where health care in America is going?

2. Why it is going there?

3. What can we expect from tomorrow's health care system compared to what we have become used to?

4. What we can do to the best of our ability to use less of it (think preventive health strategies)?

5. How we should think about and help those unfortunate individuals, young and old, who need more of it than we do?

6. How can we help to make sure those who need health care get access to good health care when they need it?

7. What can we do to increase the chances that state of the art health care will be there when we need it and at a price we can afford?

I would like this to be the place that you can visit when you hear politicians or anyone else for that matter promising something from health care that just doesn't make sense. We all know the feeling we get when we hear an "it's too good to be true" story. When we hear such fantastic promises, we better check it out and this will be a place where you can do that. So, bring your concerns and questions and I will do my best to help you to check them out!

Have you heard this one; "under my health plan, you need not to worry. Your costs will remain reasonable, you can keep your doctor and you will have access to state of the art health care". Or, "it is every ones right to access the very best in health care, young and old, rich and poor no matter your ability to pay." This would be nice but it is simply not reality and it is time that we talk about these things and deal with them with our rose-colored glasses removed. So, no matter what your point of view on this subject I encourage you to visit ask and comment. We need a grass-roots effort aimed at understanding health care and in particular we need to talk about its funding limits and what we can do to assure that those who need it - get it, and at a level of quality and at a manageable cost such that we can afford it as a nation. If we don't do this it is highly likely that health care as we have known it America will not be available when we face our own or a family members serious and costly illness.

The fundamental flaw in our individual approach to health care is the notion that we have no responsibility for it except to expect it to be there, with no delay, and at state of the art levels of care.

And that for the most part it should be paid for by someone else. Most politicians right now are not leveling with us. They don't want to address the areas that I have addressed even in this my first edition health care blog. Well, I think that we are better than that! I think with the right information we can manage through the changes that are coming. We want to do the right thing but to do so we have to be informed as to how stretched the health care system is and what we can do to unburden this precious resource.

First, we can stretch health care dollars and resources by taking better care of ourselves. The goal is to do what "we" can do in terms of learning about and practicing preventive disease strategies, thereby reducing the amount and cost of health care interventions we need. By behaving this way we free up our local health care systems funding and limited physical capacity to treat those who are truly in need.

Every one of us that invests in preventive disease strategies will find that the beneficiary is you, your family, and your finances. Pretty tangible benefits wouldn't you say? Perhaps bigger than that is what this behavior and better health for yourself and the avoidance of chronic diseases such as high blood pressure, heart disease, pulmonary (breathing) conditions, diabetes and a host of other conditions can do to unburden the nation's health care system. We need to preserve it, both in terms of resources and dollars, for those who are less fortunate and have to access the system for serious health problems.

How good would that feel?

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