Peter Hutchinson and Maureen Reed: For better, cheaper, universal care

12/24/2006

Minnesota shouldn't settle for less as it addresses reform in the health care system.


Peter Hutchinson and Maureen Reed
Star Tribune Editorial
Published: December 24, 2006


The race is on to cover all children with health insurance. The governor recently announced this is his goal; the DFL majorities in the Legislature champion the same goal. All promise they will have plans ready soon.


What these leaders want to achieve is good, but not good enough. Minnesota's health care system is dysfunctional in three ways: too many people go without, too many people are going bankrupt from spiraling costs, and too many people are suffering needlessly from substandard care.


Covering the 80,000 or so children who lack health insurance will address only one of these three failings -- the easiest one to address. It will do nothing to make things better for the rest of us. We need simultaneous changes that markedly decrease costs and improve the quality of care. We need health care that is better, cheaper and universal. Here's how it can be done:


Better: Some 30 percent of health care services are either unnecessary or ineffective. One federal government study estimated that 20 percent of all tests are done because the attending physician cannot find the results of the same test done previously. Ouch! The Durenberger Commission reported that in Minnesota best care is provided for some chronic diseases (e.g., diabetes) only 20 percent of the time. Ouch again!


Best care means the right care done right the first time. It means care based on best evidence of what works, not on past habits. We can make health care better by setting high expectations, tracking and reporting the quality of care, and then buying care from those who do it right the first time.


Cheaper: Getting best care would chop out a big chunk of the 30 percent of medicine that is unnecessary or ineffective. But there is more.


Another 20 percent of health care spending goes to support the bewildering jumble of forms, codes, letters saying "This Is Not a Bill," and administrative and bureaucratic procedures that make no contribution to our health. Minnesotans don't want government to run health care, but only government can force the players to employ a standard, sensible set of forms, codes and processes.


The results could be astounding. Consider the record of the Veterans Administration. Ten years ago the VA was regarded as among the best examples of why government should stay out of health care. But in the last decade, the VA more than doubled the number of patients it serves, reduced its staff by 10,000, kept its cost per patient flat, and achieved among the best patient outcomes in health care.


How did the VA do it? It created a single set of administrative procedures, committed to care quality, and embedded both in a single electronic system installed nationwide. After Hurricane Katrina devastated VA hospitals along the Gulf Coast, dislocated veterans seeking care in far-flung VA facilities found their records intact, their medications on file and their tests accessible. We should have a single system like the VA's in place throughout Minnesota. It would simplify, save money and improve quality.


Universal: If we make health care better and cheaper, then we can make it universal. First we should require folks to have health insurance. (Many of those who don't have it now could afford it, but choose not to buy it.) Then we should provide subsidies so those with low incomes can afford at least basic coverage for preventive, primary, mental health and catastrophic care, as well as generic prescription drugs.


Minnesotans want everyone to have access to care -- but they also want quality and affordability. We can get all three only if we make them complementary priorities, and don't settle for an easy fix of one by sacrificing the other two. A well-coordinated, comprehensive approach, with aggressive goals for all three, is not too much for us to expect.


Peter Hutchinson is a founder of the Public Strategies Group, coauthor of "The Price of Government," and was the Independence Party candidate for governor in 2006. Dr. Maureen Reed is former medical director at HealthPartners, chair of the University of Minnesota Board of Regents, and was the Independence Party candidate for lieutenant governor in 2006.