By using this site, you agree to the Privacy Policy and Terms of Use.
Accept
Health Works CollectiveHealth Works CollectiveHealth Works Collective
  • Health
    • Mental Health
    Health
    Healthcare organizations are operating on slimmer profit margins than ever. One report in August showed that they are even lower than the beginning of the…
    Show More
    Top News
    grief
    Coping With Depression from Loss After a Preventable Accident
    November 14, 2024
    medical research
    The Key to Medical Progress in Clinical Trials
    March 13, 2025
    HIPPA compliance
    How Medical Office Staff Can Make Your Practice HIPAA Compliant
    October 29, 2021
    Latest News
    7 Most Common Healthcare Accreditation Programs: Which Should You Use?
    August 20, 2025
    Hospital Pest Control and the Fight Against Superbugs
    August 20, 2025
    Hygiene Beyond The Clinic: Attention To Overlooked Non-Clinical Spaces
    August 13, 2025
    5 Steps to a Promising Career as a Healthcare Administrator
    August 3, 2025
  • Policy and Law
    • Global Healthcare
    • Medical Ethics
    Policy and Law
    Get the latest updates about Insurance policies and Laws in the Healthcare industry for different geographical locations.
    Show More
    Top News
    Image
    Emergency Room – Don’t Use It For Primary Care!
    March 19, 2013
    Encouraging Medicare News From Senate Republicans
    March 17, 2012
    chronic disease
    Lifestyles Cause Most Serious Disease and Deaths
    May 25, 2013
    Latest News
    How Social Security Disability Shapes Access to Care and Everyday Health
    August 22, 2025
    How a DUI Lawyer Can Help When Your Future Health Feels Uncertain
    August 22, 2025
    How One Fall Can Lead to a Long Road of Medical Complications
    August 22, 2025
    How IT and Marketing Teams Can Collaborate to Protect Patient Trust
    July 17, 2025
  • Medical Innovations
  • News
  • Wellness
  • Tech
Search
© 2023 HealthWorks Collective. All Rights Reserved.
Reading: Getting There
Share
Notification Show More
Font ResizerAa
Health Works CollectiveHealth Works Collective
Font ResizerAa
Search
Follow US
  • About
  • Contact
  • Privacy
© 2023 HealthWorks Collective. All Rights Reserved.
Health Works Collective > Policy & Law > Health Reform > Getting There
Health Reform

Getting There

JohnCGoodman
JohnCGoodman
Share
7 Min Read
SHARE

Imagine you are in a room full of diverse people, with differing political views and differing levels of understanding of economics and social science. You are discussing health care.

Yet despite all this diversity there is amazing agreement. You agree on the problem, you agree on the general direction of a solution and then ….. WHAM …. you discover an opinion gap so wide it’s like the difference between night and day.

Imagine you are in a room full of diverse people, with differing political views and differing levels of understanding of economics and social science. You are discussing health care.

Yet despite all this diversity there is amazing agreement. You agree on the problem, you agree on the general direction of a solution and then ….. WHAM …. you discover an opinion gap so wide it’s like the difference between night and day.

More Read

ACO’s and CMS
Where is the Device Industry’s Seat at the “Network of Experts” Table?
Healthcare in the Two Americas: Interactive Slide Show
Interview with Evan Falchuk, Candidate for Governor of Massachusetts
What Will Machine Learning Do With Healthcare In 2020?

This happens to me all the time. I find that I am in general agreement with the Obama administration, my friends at Dartmouth and even Don Berwick on four of five steps needed to get from where we are now to a better health care system. Here, for example, is how to reform Medicare:

  1. We agree there is a lot of waste in the system — maybe even one of every three dollars;
  2. We agree that quality of care differs across the system, by wide margins;
  3. We agree that we can generally identify the best (low-cost, high-quality) providers: doctors, clinics, hospitals and even entire health care regions;
  4. We deplore the fact that the best providers are generally paid less than mediocre ones and we agree that this must change; and finally,
  5. ??????

There is so much agreement on items 1–4 that we even illustrate the points with the same examples (e.g., Geisinger, Cleveland Clinic, etc.). At this point people begin losing interest. Minds begin to wander. But it is the last detail that will crucially determine whether the reform succeeds or fails.

Okay, reader. What’s your number five? I’ll give you mine below the fold and readers can find more details here.

Goodman’s number five: Tell all of the people who are practicing medicine in a different (and apparently better) way that you will pay them in a different way and increase their total payment by some fraction of the amount they are saving the government. Then announce to all other providers you are willing to pay them in any different way they propose, provided that the government’s cost goes down and quality of care for patients goes up.

Obama’s number five: Ignore all of the centers of excellence and all of the people practicing in them and publish a 429-page book of rules, detailing what the providers must do if they want to be paid more. Pay less to any provider who doesn’t follow the 429 pages of rules.

Am I exaggerating? Maybe. But I’m not exaggerating about this:

  • Under Obama’s approach, government is the main actor. Under my approach, the providers are the main actors.
  • Under Obama’s approach, government decides how to define and measure quality and cost. Under my approach, providers are completely free to propose new and better ways of defining and measuring these things.
  • Under Obama’s approach, providers have only one real incentive: maximize against reimbursement formulas. Under my approach, providers have an incentive to find new and better ways of delivering medical care.

I’ll use an example I’ve used before: Jeffrey Brenner, the Camden, New Jersey doctor who identifies the sickest, most expensive patients and lowers their overall health care costs by getting the patients to change their lifestyles. Because most of what Brenner does is effectively social work and because there is no current procedural technology code for social work, Brenner is essentially working outside the system. He is saving Medicare and Medicaid millions of dollars; but these bureaucracies are doing nothing to reward him for his efforts.

Pro-ObamaCare writer Atul Gawande wrote about Brenner in a widely read article in The New Yorker and I found myself agreeing with everything Gawande wrote. Except for one paragraph, in which he asserted that the Obama administration’s goal was to encourage Brenner’s approach all across the country.

Nothing could be further from the truth. The administration is giving Brenner not one thin dime for his exceptional work. In fact Brenner is surviving and paying the rent only because of help from nonprofit foundations. For Brenner to get government help, he must jump through all kinds of hoops and try to qualify as an Accountable Care Organization!

[BTW, this is the only point in Gawande’s article where he becomes sloppy — treating step five as though it were an unimportant afterthought.]

My solution: Give Brenner 25% of all the money he’s saving the federal government. Let him become a millionaire. Then invite every other doctor in the country to copy Brenner’s example, or even improve on it.

When people hear of my approach the most common reaction is disbelief that a government agency could actually pull it off. But what I have in mind is not all that different from a lot of things the government already does. We put out bounties for the head of Osama bin Laden and for the capture of other dangerous criminals. We let whistle blowers share in the savings they help snare. What’s so hard about rewarding people who find ways to save the government health care dollars?

I will readily admit that government is not the ideal vehicle to pull this off, however. That’s why we need to transfer more control over health care dollars to patients and to private health plans. More efficiencies will emerge if both sides of the market have incentives to find them.

   

TAGGED:healthcare reform
Share This Article
Facebook Copy Link Print
Share

Stay Connected

1.5kFollowersLike
4.5kFollowersFollow
2.8kFollowersPin
136kSubscribersSubscribe

Latest News

engineer fitting prosthetic arm
How Social Security Disability Shapes Access to Care and Everyday Health
Health care
August 20, 2025
a woman explaining the document
How a DUI Lawyer Can Help When Your Future Health Feels Uncertain
Public Health
August 20, 2025
physiotherapist at work
How One Fall Can Lead to a Long Road of Medical Complications
Health care
August 20, 2025
Common Healthcare Accreditation Programs
7 Most Common Healthcare Accreditation Programs: Which Should You Use?
Health News
August 20, 2025

You Might also Like

healthcare reform
Health ReformPolicy & LawPublic Health

Obamacare Simplification: Is That Like “Jumbo Shrimp”?

May 1, 2013
health reform politics
Health ReformPolicy & Law

Providing High-Quality Health Care to Americans Should Trump Politics

October 6, 2013

Moving mHealth to the Next Frontier: Aligning Patients, Physicians, Healthcare Providers & Payers

June 10, 2012
Health Reform

Keys To Proper Disposal Of Pharmaceutical Waste

October 16, 2019
Subscribe
Subscribe to our newsletter to get our newest articles instantly!
Follow US
© 2008-2025 HealthWorks Collective. All Rights Reserved.
  • About
  • Contact
  • Privacy
Welcome Back!

Sign in to your account

Username or Email Address
Password

Lost your password?