Putting Health into the Reform Equation

In the current debate over healthcare reform, there are three areas that receive the most attention from legislators – access, cost, and quality.  One of the first points that most legislators make when discussing the healthcare system and the need for reform is undoubtedly the issue of access.  How many times have we heard a politician speak about the 47 million insured?  Immediately afterwards, the conversation usually turns to the issue of costs.  Often times, a politician will point out that, “America spends twice as much per capita as any other industrialized nation in the world on health care.”  Of course, this is a perfect segway into the issue of quality.  Most legislators like to highlight, “that even though we spend twice as much per capita on healthcare as any other industrialized nation, the World Health Organization ranks us 37^th in terms of quality.”  Undoubtedly in the debate over healthcare reform, these issues are essential, but are policymakers missing something that contributes to the nation’s health?   

 If you look at any healthcare reform proposal, such as the Wyden Bennett plan, the plan will almost assuredly talk about access, cost, and quality.  However, most proposals only truly address the issue of access and do very little to address cost and quality issues. Even if we were to accomplish the goal of increasing access, lowering costs, and improving quality, we are still only tackling a small portion of the healthcare problem.  In the United States, our focus is in large part on an episode of illness, better known as the “care” part of the “healthcare” equation. 

 To really solve the healthcare crisis America needs to retool the system to start better addressing the “health” side of the equation as well.  In our last post entitled, “Your Buck Stops Here,” we used an analogy about paying lawyers to explain why Americans don’t receive certain care.  The analogy was as follows:  

“If we paid attorneys in the same manner that we pay doctors, you might pay your lawyer $500 an hour for a closing statement, while only paying him $100 an hour for jury selection. Odds are that due to this differentiation, your lawyer is going to work hard for hours on end to craft an exquisite closing statement, but as a consequence spend less time selecting a favorable jury. In the end, what good is a compelling statement, if the jury is made up of anything but your peers?”  This is exactly the problem with our current healthcare system -- all of the incentives are focused on curing an episode of illness, rather than towards promotingl health.”

We believe that in order to create a truly sustainable healthcare system, we have to start placing more emphasis on keeping people healthy instead of focusing on fixing them once they are broken down. 

A well regarded article by Foege and McGuinness in the New England Journal of Medicine in 1993, pointed out that access to quality healthcare accounts for 10-15 percent of variation in health outcomes, while behavior accounts for 40-50 percent, genetics 15-20 percent, and environment 25-30 percent.  According to a 2008 study by the Milken Institute, over 109 million Americans report having at least one chronic disease, costing the economy an estimated $1.1 trillion a year.  Given the impact of behavioral determinants on American’s health and the cost of chronic diseases to the nation, we must ensure that the system emphasizes preventing episodes of illness, if we truly want to improve the health of the nation and put healthcare on a sustainable trajectory. 

 As the policy debate continues in Washington on healthcare reform, the goals of increasing access, lowering costs, and improving quality is not only admirable, but also essential in reforming the system.  However, we must not ignore the “health” side of the equation if we want to truly improve the nation’s health and its care.