Saturday, February 19, 2005

A Philosopher’s Suggestion

In response to my challenge for concrete suggestions on redesigning the health care system, the following comes in from daughter Eleanor. Eleanor teaches Philosophy at the University of the Pacific in Stockton, California. She also served a term on the Water Board of Half Moon Bay, California and was for a time its President.

I think we as a society need to answer two pretty basic questions; 1) Are we going to hold individuals ultimately responsible for their own health or illness? Or is there a floor below which we just won't let people sink. (e.g., are we willing to let people die of infections or injuries that could easily be treated because they can't afford/choose not to purchase insurance? Or do we hold the view that decent people make sure everyone gets some basic level of medical care?)
2) If we decide we are not willing to just let people die because they are poor or irresponsible, then we have to address a trickier question: how much care? and how do we pay for it. (ex hypothesi, the poor and irresponsible are not going to bear the brunt of the cost - if they could or would they wouldn't be poor and irresponsible.)

It has always seemed to me that if our answer to the first question is that we are not really a very cold hearted people, then the natural approach to the question of insurance is that we all mutually insure. On the theory that none of us know who is going to get sick or injured, we should make sure we all chip in enough that everyone who needs gets taken care of. That is my theory of how health insurance ought to work.

This business of making insurance a for-profit enterprise has only one thing to recommend it: in theory it tends to drive prices down. The downside is that in practice it tends to drive sick people out, and so defeat its purpose.

Here is my suggestion: make health insurance a public utility with an elected board of directors. State, County, City, who can tell which size will work best. This form of organization tends to keep costs low (lowering rates is always popular with taxpayers!) includes everyone, (you get covered according to where you live) is sensitive to local needs, and can balance local expectations and standards with ability to pay. The folks in charge ONLY have an incentive to keep costs low while keeping services high.

They also have an incentive to partner up with local folks who can do something about public health and preventive care. Water districts do more to encourage water conservation here in California than anyone else. Kind of odd if you are in the business of selling water to help people buy less, but that's the fact.

I know it is not very PC these days to suggest that government might do something well, but think about it: wouldn't you like to take your insurance coverage for granted in the same way you do your water service?

Monday, February 14, 2005

Who, Me?

Friend, colleague during Houston days, and recovering Pediatrician Jeff Ackerman has the below to say in response to the 02/03/05 posting titled The O’Neill Factor:

Jeff is now President and CEO of San Jacinto Methodist Hospital, part of the Methodist Health Care System based in Houston.

I enjoy reading your blog and your comments but must take issue with this article and more specifically the statement that CEOs should publicly stand up and take responsibility for everything that happens in their hospital. While I personally feel that way, public disclosure does not improve anything but does set me up as a target for lawyers. I can see the court room scene now.

Plaintiff's lawyer: "Dr. Ackerman, is it true that you have publicly stated that your are responsible for everything that happens in your hospital?"

Ackerman: "Yes."

Plaintiff's lawyer: "Then you admit you are responsible for the fact that Mr.
Smith died from an anaphylactic reaction to the dye used in his cardiac catheterization?"

So what does Ackerman now say when this is a known albeit small risk
explained to the patient. Take any other adverse event that is a known
risk of a procedure or medication. I suggest we should take responsibility and act like everything is our responsibility but declaring it publicly adds nothing to the equation.

Thursday, February 03, 2005

The O’Neill Factor

The January 24 issue of Modern Healthcare has an article about Paul O'Neill, the retired Alcoa CEO who was (briefly) George W's Secretary of the Treasury. When he went back to Pittsburgh, he went onto the Board of the University of Pittsburgh Medical Center. He recently resigned from that, saying that UPMC was not serious about wanting to improve. He wanted them to eliminate medication errors. One surmises from the article that they just smiled at him indulgently.

He has also helped form something called the Pittsburgh Regional Healthcare Initiative, of which he is now CEO. PRHI has the goal of improving health care safety and quality. The reaction of the UPMC apparently has been cool.

Speaking of the state of health care in the U.S., O'Neill is quoted as saying "It’s just unbelievable to me how accepting society is of scandalously low performance standards in health and medical care."

He also said that there is not a hospital administrator in the country that has "publicly declared that they are responsible for everything that goes on in their facility, including most importantly for everything gone wrong - that they are personally responsible." He said that without that conviction and commitment, it's almost impossible to fundamentally change the status quo.

I couldn't have said it better myself.

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