June 3, 2008

Building a National Health IT Infrastructure

Our health care system is in serious trouble.

I have heard from countless Rhode Islanders who have struggled to pay for their health care and who live in fear of losing insurance coverage on which they and their families depend. I have met nurses frustrated and heartbroken that they must spend so much time filling out paperwork and so little time caring for patients. I have talked with families whose lives and health were shaken by terrifying medical errors–misplaced paperwork, mistaken diagnoses–that could have been avoided.

Today, America’s health care system yields unsatisfactory results at vast expense. The number of uninsured Americans is climbing, and it will soon break 50 million. The annual cost of the system exceeds $2 trillion and soon is expected to double. We spend 16 percent of our gross domestic product on health care, which is more than any other industrialized country and double the European Union average. There is more health care than steel in Ford automobiles, and more health care than coffee beans in Starbucks coffee.

Worse still, for all this money, we get a mediocre product. We have the best doctors, the best nurses, the best equipment, the best procedures and the best medical education in the world, yet as many as 100,000 Americans are killed every year by unnecessary and avoidable medical errors. Life expectancy, obesity rates and infant mortality rates are much worse than they should be by most international measures. And the system itself does not work: hospitals are broke, doctors are furious and paperwork chokes the system. Quarrels between providers and payers drive up costs, while potential savings are left on the table. More families go into bankruptcy because of health care expenses than because of any other reason.

Remedying Market Failure

Health care’s fundamental problem is market failure. Market forces are bottled up, conflicted, logjammed and misdirected. I believe in market forces, but it is our job in government to create an environment in which market forces operate in a way that benefits the public. Where that healthy environment for market forces does not exist, government must act.

The market failure in health care has three core components. First, the American health care system does not optimize quality or invest in prevention, even where improved care would lower cost. Second, health care does not have the information technology infrastructure to support the improvements we need. Third, the health care payment structure is at odds with public interest.

I want to discuss one of these problems in detail: our inadequate health information technology infrastructure. Several very respectable groups have examined potential savings from adequate health information technology. The Center for Information Technology Leadership estimates $77 billion in savings. The RAND Corp. estimates $81 billion. David Brailer, M.D., former National Coordinator for Health Information Technology, estimates $100 billion. That’s a lot of savings–savings desperately needed by American businesses and American families.

Government has several jobs to do here. First, we have to set some ground rules. In the old days, when our nation was building railroads, the government set the requirements for what the railbed had to hold and how far apart the rails should be. This ensured that a boxcar loaded in Providence could be sent to San Francisco without having to interrupt its journey to be reloaded onto a new track.

In health IT, we also need ground rules: rules for interoperability among systems, rules for confidentiality and security of data, and rules for the contents of an electronic health record. Setting those ground rules is a task our federal government needs to assume.

The second job is to get adequate capital into the market. Software costs money. Hardware costs money. Entering data costs money. Most important, changing the workflow of hospitals and doctors’ offices takes time and money, and it distracts from attention that might otherwise be given to patients. Developing adequate health IT will not be cheap. But for savings of $81 billion a year at a minimum, it’s not only worth it, it’s a fiscal imperative. So how do we get the capital flowing?

Public-Private Partnership

I looked around for a useful model, a model that provides the central decision-making that is required to get the boxcars rolling, a model that provides access to capital and a model that captures the vibrancy of the private sector. And I found one.

Years ago, there was a new technology that, like health IT, would transform an industry. It would lower costs and expand service, and it was a win-win situation for business and consumers. But the technology was stuck in a political and economic traffic jam. Our president at that time came up with the solution. The technology was communications satellites, the president was John F. Kennedy, and the solution was COMSAT.

The COMSAT legislation created a publicly chartered corporation with a private board that raised the capital, launched the satellites, was profitable and successful for decades and eventually merged into Lockheed Martin. It’s a true public-private success story. My proposal, in a nutshell, is to create a not-for-profit, modern COMSAT for health IT.

Because of the complexity of the health care information technology puzzle, legislation is too blunt an instrument to work out all the details. But an organization like this can be flexible enough to adjust to the demands of the market and can maintain the expertise needed as the plan develops. In addition, great leaders could be recruited from the private sector to lead this board, such as CEOs from the IT sector, America’s top retailers, manufacturers, and service providers, the champions of health information technology in the medical community, enlightened consumers and labor representatives.

Imagine the benefits: enormous cost savings, new technological horizons, empowerment of patients, better quality of care, more convenience and efficiency, and lives saved through improved information, error reduction and decision support. This could open up an extraordinary future for American technology companies, American health care providers, American patients, and American manufacturers drowning under health care costs. It’s time to put some key reforms in place that will break the economic logjam now standing in the way of a critical step toward ensuring that all Americans have high-quality health care they can afford.

Sen. Sheldon Whitehouse represents Rhode Island in the U.S. Senate.

By: Sheldon Whitehouse