Make Medicine Better

Health reform in some guise appears imminent despite the efforts of opponents to demonize and distort the intent of such reform. The topic dominates the print and electronic media, particularly when some outrageous claim is made concerning the proposals taking shape in Washington. The lack of civility that has characterized the past few months is troublesome. But there are other troublesome aspects to the debate that are less obvious but ultimately more important.

The issues that have been attracting attention are several―the public option, insurance exchanges, outcomes research, and insurance regulation come to mind. These are pocketbook issues for major players in the current health system which at least in part accounts for the attention they receive. Hardly mentioned are other matters that in the long run may have more to do with the success or failure of health reform (however it turns out) than these hot button items.

Each of the drafts circulating in the House and Senate has language concerning disease prevention and disease management but these have received little attention in the debate. In the long run, the success of any reform will hinge more on the commitment and investment in prevention and disease management than on whether there is a public option or co-ops or a trigger mechanism. If prevention is short-changed in reform, either conceptually or financially, the cost spiral that has fed the need for reform may continue. If it does, then reform will never live up to its potential to improve the health of the nation.

A second issue firmly under the radar in the current debate is the impact true reform will have on the demand for health workforce, particularly in primary care. Success in reforming the delivery system will hinge in large part on improving the organization of services and the continuity of care provided. An emphasis on the “medical home” is central to several of the proposals, but there is little attention to who will be home when a patient needs care. Increasing the investment in primary care workforce in tandem with the implementation of system reform is essential to its success.

Finally, there is no attention being given to another matter that is critical to the success of any reform―health literacy. Every plan on the table envisions patients making informed decisions, participating more actively in their care and using the system more intelligently. Without changing the current and well-documented low level of health literacy throughout the U.S. population, that deficit will also adversely impact efforts to make health reforms succeed.

Compared to the costs of treating failures of prevention these are small ticket items. An investment in them will not generate profits, but failure to do so will generate losses that may ultimately void the gains from health reform.

Tags: healthcare reform