Last week on Wall Street evidences Ch-Ch-Ch-Changes, eh? The price of panic may be high. Damn. I knew I should have converted to gold bouillon last year. But, our question for today is: Will the financial crisis affect health care?

Ohhhh, yes it will. But, heck, let’s all pretend everything is OK for now for discussion purposes, since both Presidential candidates and most Congressional committee chairs have said (see old posts here and here) they plan to move ahead with major reform, despite the financial crisis.

President Doug Weaver and I attended the annual health reform invitational think-tank called the Health Sector Assembly (HSA) this weekend, where we  addressed the topic of health care financing with 50 of the nation’s most influential health constituencies from both sides of the aisle, representing employers, consumers, government (HHS), foundations, industry, economists and selected providers. It was a bit of a food fight over how to solve the problems, or about if really have problems for some people. But, if clarity is power, it’s easy to see how lacking in power we are as a nation in heading off an impending crisis in health care costs, outstripping the ability of individuals, employers, and government to afford care.

The banking crisis was based on an unsustainable system that few people involved apparently wanted to face honestly. Could we be the next big nightmare? At this meeting we heard that the unfunded annual contribution to the national deficit for Medicare, Medicaid, and privately funded health care is in the one-two hundred billion range, and (if we don’t semi-radically change the game) this health deficit will be over $900 billion a year in less than a decade, assuming the health system continues to grow 2.5% faster than the GDP -- as it has over the past 2 decades. This year employer insurance is going up 7-10%. Sustainable?

Some outspoken economists and members of this group (doctors among them) are basically saying the Party’s Over (it’s just a very few years away still). So, this meeting is about heading that crisis off now. The question is: (thinking of the bankers) do we really want to? Will we face it? [more]

Potential solutions posed at this HSA meeting were:

• Both presidential candidates plan to spend $1.3-$1.6 trillion (that’s with a “t”) over 8-10 years with their health reform plans. So, we need to explain to both political parties and campaigns that BIG costly fixes will have to wait until military conflicts and the financial crisis are over. But, in the meantime, we can begin to decide what the reforms should be!
• Go for low-cost/high-value interventions for the short term. These could include:
  

• Physician and hospital payment reforms to improve quality, including incentives for e-reporting through registries related to outcomes, adherence to guidelines, appropriate use criteria, and variation in resource use based on clinical data (this is what ACC has been suggesting).
• Improving coordination of care and hand-offs (the Medical Home or similar concept that we have been focusing on in our discussions).
• HIT adoption incentives to support the above (meaning the government needs to step in to deal with interoperability standards, privacy rules, and maybe a patient identifier---again which are ACC priorities)
• Comparative effectiveness research (We agree if done right).
• Reducing unnecessary readmissions by coordinating patient care hand offs and adherence to life-saving medicines (We agree again)
• Prevention strategies that pay off sooner and cost less to implement (flu shots, pneumovax, medication adherence in high cost diagnoses, etc).

• Involve the profession and patient advocates in designing and implementing the above.
• Explore expanding access to care concepts that don’t radically increase costs (The Wyden Plan comes to mind as a starting point).
• We also talked about whether we can reform the system so that we can keep the total health care pie (currently at 16% of GDP) at the current level or lower -- heading off the projected catastrophe -- by getting the nation, the Congress, and the health sector constituencies to agree to that.  Note that we’re already spending so much more than other nations that this kind of goal could increase competitiveness in the global economy for our companies as well.

What do you think: Will the financial crisis affect health care reform efforts? How?

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