Yesterday we presented an analysis of the Bush administration's Darwinian health care agenda, based on an important new policy briefing from David Kendall of the Progressive Policy Institute. But Kendall's paper also lays out a progressive alternative agenda that would move our health care system in the right direction and deal with the big challenges of cost, coverage, and quality.
This agenda has seven key steps:
1.) Restrain costs by improving quality. Paying doctors and hospitals according to the health results they achieve, rather than the quantity of services they provide, could make the entire system vastly more efficient and effective. The federal government should spur regional efforts, backed by the combined purchasing power of employers, insurance companies, and government programs, to push for this "quality revolution," through such means as provider comparison report cards, a focus on health promotion and disease prevention, and greater use of evidence-based medicine.
2.) Give all Americans the health coverage members of Congress enjoy. The Federal Employee Health Benefits (FEHB) gives federal workers a wide variety of excellent private health plans to choose from. The federal government should create a new partnership with states to universalize this approach, with Washington helping finance coverage for those without it, and the states setting up systems to make it available either through FEHB or a state-developed program with comparable features.
3.) Require shared responsibility for the cost of coverage. All Americans pay for the cost of medical treatment of people without health insurance. Government should pay for coverage for those who cannot afford insurance, but those who can afford it should be required to buy it.
4.) Advance the use of information technology through a health information
network. Bringing the health care system fully into the digital age could
enormously reduce medical errors, spread medical "best practices" throughout the system, and reduce costs. But only the federal government is in the position to create a national network for exchanging health information electronically, giving
patients the ability to give providers access to medical records without sacrificing privacy.
5.) Create health courts for fair and reliable justice in malpractice cases. The real scandal of medical malpractice is not large jury awards, but how few injured patients receive timely compensation, and how little the system encourages better medicine and fewer life-threatening errors. Congress should create a national network of specialized "health courts" similar to those that handle workers' compensation claims.
6.) Reform Medicare and Medicaid by creating accountability and choice. Today the two biggest public providers of health insurance are reactive regulators and paymasters for health services, not proactive managers responsible for improving health care quality and access while restraining costs. The key principle for Medicare and Medicaid reform is to make that change in role decisively, while giving beneficiaries real choices in health plans and access to services tailored to their individual health conditions, while making cost-conscious decisions.
7.) Create a National Cure Center to speed medical breakthroughs. Finding and deploying cures or effective treatments for widespread chronic diseases like diabetes could have an enormous impact on health care costs while saving lives and creating a healthier America. Congress should adopt Sen. Joe Lieberman's proposal to establish, within the Institutes of Health, a National Cure Center whose mission is to accelerate breakthrough medical research, and speed its implementation among medical practitioners.
These seven steps would modernize the health care system, strike the right balance of collective and individual responsibility for health care, finally make health insurance universal, and create a virtuous cycle of better quality and lower costs. By bringing the U.S. health care system fully into the 21st century, it's an appropriate progressive alternative to the Bush administration's efforts to take the system back into the distant past.
