October 28, 2008

Whitehouse & Gingrich: Next president must put health in health care

In the race for president, Sens. John McCain and Barack Obama have put the issue of health care back in the spotlight.

This may seem off message, given the turmoil in the financial markets, but they are right to return to it. Lest we forget, health care is one-sixth of our economy – more than $2 trillion every year – and it is badly broken.

Like millions of our fellow Americans, we are deeply frustrated with our health care system. We remain alarmed watching it consume 16 percent of our GDP and growing, watching our infant mortality and obesity rates climb to levels of international embarrassment, knowing 100,000 Americans are killed each year by avoidable medical errors, seeing health care costs crush American businesses and debilitate our competitiveness abroad, watching an estimated 50 million Americans suffer without insurance coverage, and hearing of so many American families going into medical bankruptcy.

We also see catastrophic implications looming for our federal budget. Medicare and Medicaid consume 4 percent of our current GDP and will hit nearly 20 percent by 2082. For Medicare, the federal government is on the hook for an estimated $34 trillion or more in 2082 – and we have done nothing to meet this liability. We are on an unsustainable path.

2009 must be the year that Congress and the president, whoever he may be, pursue meaningful and thorough health reform.

So far, the debate has been dominated by talk of financing, access and coverage. Health reform means much more than just expanding insurance coverage. To be sure, every American deserves health insurance, but they also deserve cost-effective, high-quality care. Right now, simply having health coverage is no guarantee of quality care.

That is why any legislative efforts in 2009 must put the health back in health reform.

First and foremost, we must make a serious investment in health information technology (IT). Health care is the last and largest segment of our economy that still refuses to embrace technology from the 20th century, let alone the 21st century.

Health IT should be what railroad tracks were for transportation 150 years ago: basic infrastructure. A modernized, interconnected health system that electronically links patients, physicians, hospitals, pharmacies, public health agencies, payers and key emergency responders would allow all to share accurate, patient-protected information, and that will undoubtedly save lives and save money.

The Congress and the new president must call for the creation of this nationwide, electronic health system by December 2012 – the end of the next president’s first term.

That is bold, but there are models of presidential leadership to follow. For example, 52 years ago, President Eisenhower signed the Federal Aid Highway Act, which authorized the construction of more than 40,000 miles of interstate highways and appropriated $25 billion over 10 years. This was a vast sum of money, considering that total federal spending in 1956 was $70 billion, making it one of the nation’s highest priorities. But who can argue the investment did not pay dividends far beyond the initial cost? So, too, would an electronic health system today.

Second, health IT will allow us to capture data and then determine which treatments work and which do not. Today, only about 10 percent of all health care is based on evidence. That means that 90 percent of the care we receive is, basically, informed opinion. We need a rigorous, clear system to measure the costs, benefits and value of a given procedure, technology or drug.

A comparative effectiveness institute also can collect and understand the best practices of the country’s best providers of care. There are innovators out there, such as Intermountain Healthcare in Utah and Mayo Clinic in Minnesota, that deliver the best possible care at the lowest cost.

A comparative effectiveness institute, particularly one energized by local centers of innovation at the state and regional level, could not only educate other providers on how to improve, but also inform policymakers on how to design policy that promotes these best practices.

Lastly, we must change the way we pay for care. Right now, we pay for all the wrong things. We do not pay doctors to coordinate care, to deliver care with electronic health records, to focus on prevention or to teach healthy behavior. We pay family doctors the least of all specialties, even though these physicians are often in the best position to provide low-cost, coordinated care.

On the other hand, we pay doctors more the sicker their patients are, more for each additional service they deliver and more for each additional test they perform.

There is no magic here: We simply need to pay more for what we want more of, and less for what we want less of. These priorities are absolutely essential. We will never cover the uninsured or resolve the looming budgetary nightmare without them.

That is why lawmakers from both parties must focus on health-based health reform next year. The American people deserve nothing less.

Former House Speaker Newt Gingrich, a Republican, is the founder of the Center for Health Transformation. Sheldon Whitehouse is a Democratic senator from Rhode Island.

By: Sheldon Whitehouse and Newt Gingrich