To Save America: Stopping Obama's Secular-Socialist Machine (24 page)

These structural entitlement replacements would solve the long-term entitlement crisis without tax increases or benefit cuts. The
new, transformed safety net would serve the poor and senior citizens far better while reducing the size of government.

Now
that
would be change you can believe in.

With Nancy Desmond CEO, Center for Health Transformation

 

 

 

O
bamaCare, like HillaryCare, is a dead end of higher taxes, bigger government, more bureaucracy, and a decaying health system.

However, the American people know we need health reform. So just saying no to ObamaCare won’t do. We need to offer a better solution.

Our task is both to expose the disingenuous and destructive heath proposals of the secular-socialist Left and to promote and communicate a better system that will improve health outcomes, strengthen individual rights, and boost the economy.

It is impossible to save America without fundamentally improving our healthcare system. Morally, we cannot accept the needless death and suffering of millions of Americans each year from avoidable
medical errors, preventable chronic diseases, and the lack of integrated information in our current system.

Nor can we as Americans accept a future where, according to analysts, we will be the first generation where our children and grandchildren are likely to live shorter and less healthy lives than the generations that preceded them.

Furthermore, we cannot save America without solving the economic challenges related to the costs of our current inefficient healthcare system. We cannot balance the budget or rein in the deficit without fixing what ails our healthcare system. Similarly, we can’t create jobs competing in the world market if our healthcare system is dramatically more expensive than those of our competitors.

The current debate over covering the uninsured is a prime example of our unfortunate tendency to focus on only one part of the healthcare system. By concentrating on who we should tax in order to expand government coverage to more Americans, politicians are missing the real opportunity to rethink and transform the health system. The fact is, it is possible to have 300 million Americans living longer and living healthier in a twenty-first century intelligent health system with 100 percent coverage, but it requires changing much more than just financing.

At the Center for Health Transformation, we know the potential for positive transformation is enormous because we have spent years developing effective approaches and studying successful health innovators around America.
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When everyday Americans consider healthcare reform, they do not focus on the nuances of insurance collectives and industry jargon. Rather, they ask the simple questions:

As we consider the best way to transform our healthcare system, we must assure access includes these three elements.

There are regions of our country that don’t have a single doctor, and there are others with plenty of hospitals and clinics, but where ill people cannot physically get to that care.

A twenty-first century healthcare system must use creative initiatives like medical education debt forgiveness to train more physicians and incentivize careers in primary care, especially in rural communities.

We must also transition from a physician-centric model to a physician-led team model of care that empowers and utilizes other medical professionals such as clinical nurse practitioners, physician assistants, pharmacists, and social workers who can provide distributed models of care that reach people where they live including in their homes and not just in hospitals or doctors’ offices.

Most important, we must ensure that the pipeline of discovery and development of innovative medical products is nurtured by public and private investment so that cures become available for advanced cancer, Alzheimer’s, diabetes, pandemics, and other ills.

Many Americans wonder why the cost of their healthcare rises while the cost of flat screen TVs and cell phones decline even as their quality improves. The simple answer is that there is waste and inefficiency across the entire spectrum of discovery, development, and delivery of healthcare.

Creating a twenty-first century healthcare system that is affordable to both our nation and to every American requires a systematic effort at process improvement that is quality-focused and cost-conscious.

Expenditures for healthcare at the macro or national level as a percentage of GDP can be viewed as having two components: the purchase of goods and investment in research. This is no different from any other business model predicated upon continuous product improvement. When you purchase your computer, you are paying for the computer itself and all its features, but you are also providing the manufacturer with funds to do R&D to produce a better version tomorrow. Successful businesses have turned this model into an art form—they had to, because their survival depends on it. The healthcare system has created chaos in this process, and that must change; our personal survival depends on it.

The current system of medical research is broken. It’s too slow (approximately ten years for the development of a drug and seventeen years for a discovery in the lab to be translated into a life-saving treatment in the clinic); it’s too expensive (approximately $1.5 billion to develop one drug); it’s too risky (only one out of a thousand
compounds ever makes it into the clinic as a drug); and it’s too fragmented (there is a lack of seamless integration between basic, translational, and clinical research essential for product development). The federal government, working through agencies such as the National Institutes of Health, the Food and Drug Administration, and the Center for Medicare and Medicaid, in conjunction with academia and industry, can radically improve this process of turning new knowledge into new cures.

The system of product delivery today is plagued by fraud and abuse, contributing to a dramatic waste of money, time, talent, and expertise. Crucially, healthcare providers lack an adequate modern information technology system. Not only does our current paper-based system kill patients through unnecessary errors and inefficiencies, but it is killing the fundamental system of care delivery.

Visitors should be appalled by the number of forms they must fill out at most health facilities, and at the way the same process is repeated at every place within a facility. We can do better. Modern medical facilities like the Mayo Clinic, Intermountain Healthcare, Gundersen Lutheran, Sutter Health, and the Cleveland Clinic have found a better system of electronic medicine that makes a person’s healthcare portable. It also improves access to data among different facilities in order to avoid unnecessary duplication of medical tests and procedures, a problem that costs significant money and time to both patients and doctors.

Whether apparent or not, fraud and abuse affect every person’s healthcare. Stopping the thieves will save the system hundreds of billions of dollars per year. That’s why eliminating fraud is essential, as described in the next chapter.

A twenty-first century health system can assure every American access to continuously improving, affordable, state-of-the-art care,
just as we always expect to see better TVs or cell phones. It requires a new business model in which each producer or provider strives to produce the finest quality product or service in the most efficient manner, and the government creates a regulatory framework that assures these products and services are integrated into an efficient system that offers real choice to consumers.

Perhaps Americans’ most important healthcare concern is to receive the right care for the right reason that achieves the right outcome. In fact, there is no other reason than this to seek professional care. People trust and depend on the medical profession to consider their unique needs and to have the expertise and tools necessary to assure personalized care.

In the past, physicians made a diagnosis according to patient history, physical exam, lab tests, and X-rays. Then, based on treatments approved by the Food and Drug Administration (FDA) that had been tested on others, they prescribed a treatment plan, and both patient and physician hoped for the best. This hit or miss process should be a thing of the past.

Thanks to breakthroughs in science and technology, we will soon be able to radically transform healthcare so that treatment is no longer based on
population
medicine, but on
personalized
medicine.

This can begin with modernizing the FDA, which should create a science-based regulatory framework to approve medical products based on the scientific knowledge of their mechanism of action in individuals, not just on the observation of outcomes in large populations. By implementing this framework within large and diverse healthcare delivery systems, modern information management systems can monitor performance of medical products after regulatory approval. This can allow us to continuously define and communicate to patients and physicians the safety and effectiveness of those products.

We must also create a strategy for individual wellness that enables healthcare providers to use emerging tools of science and technology to identify risk or susceptibility to disease, and to personalize prevention strategies relating to lifestyle, nutrition, access to early detection, and continuous health management. Numerous creative interventions are now being developed that empower individuals to continuously engage in managing their own health using wireless at-home systems. Those systems can monitor health parameters and provide guidance for prevention interventions to Internet-based and employer worksite programs that promote wellness.

Appropriate care is the key to optimal quality at the lowest possible cost. For example, the FDA recently commissioned a study to use genomic data to help define the optimal dose of Coumadin, a blood thinner widely used to prevent blood clots. By using this new technology to better provide the right dose for patients, the right outcome was achieved. Fewer patients were under-dosed, which could cause continued clots resulting in strokes and other serious problems, and fewer patients were over-dosed, which could necessitate emergency treatment for bleeding. In spite of the cost of doing the genomic test in all patients, the projected cost savings for one year due to reduced complications requiring additional medical care reached hundreds of millions of dollars. The real story is not just saving money, but saving people the horrendous burden of an unnecessary stroke or hemorrhage.

To create a system of better healthcare at lower cost, we have to stop fighting over how much it would cost to expand the current
system and talk instead about real change in the four distinct but interrelated boxes of health and healthcare:

The Individual. A personalized health system will only work if the individual is empowered and engaged. This requires people to be equipped with the knowledge and access they need; they also have to understand, accept, and be incentivized to make responsible choices.

In this system, you will have more individual rights but also more responsibilities. You will have access to more information and choices but will be expected to become partners in your own health and healthcare. Even the best doctor, of course, can’t help a patient who is unwilling to comply with medical and preventive recommendations.

 

The Culture and Society. We need to maximize positive cultural and societal patterns for a healthy community. This includes changing the policies, institutions, and environment that impact the choices made by individuals.

For example, given the current epidemic of childhood obesity, we should insist that schools serve healthy lunches, offer healthy snacks, and include physical education as part of the daily curriculum. Likewise, if we encourage healthy diets but high-risk neighborhoods have no access in their local stores to fresh fruit and vegetables—or if healthy food is prohibitively expensive—we will probably not have much impact.

 

The Delivery System. We have to create an effective, efficient, and productive health delivery system. This means we must adopt new technologies, new models, and a new culture. A future where the healthcare system focuses on the individual, where learning is constant and in real-time, and where innovations are much more rapidly driven through the system will require a different type of delivery system. There will be more partnering, increased reliance on IT-ASSISTED knowledge and expert systems, and an emphasis on health professionals acting as consultants to one another.