DESMOND & FRAKES: Courting need to readdress health care reform

OPINION:

For almost two years, Americans have lived in limbo - not knowing if the 2,770-page health care reform law would forever change how we conduct the business of health care. This week, we found out that an answer is not far away. The U.S. Supreme Court has agreed to hear the legal challenge to President Obama’s signature health care law, which was drafted with little public input; created 159 new agencies, offices and programs; and granted a litany of unchecked powers to a few Washington bureaucrats, most notably the secretary of health and human services.

The nine members of the nation’s highest court will decide not only whether it is constitutional for the federal government to mandate that citizens purchase health insurance but whether the federal government can force states to expand their enrollment in Medicaid.

The legal arguments to be heard in the spring will be the Super Bowl of Supreme Court cases, and the court’s ruling will be one of the most heavily anticipated outcomes in years. It should have a profound effect on the 2012 presidential election as well as the health care industry, which represents more than one-fifth of the entire American economy.

Whether the court throws out the entire law, upholds it or rules parts of it unconstitutional, we believe there is a need to put in place legislation that focuses on a 21st-century model of health care reform, one based on a patient-centered model that lowers costs while improving health outcomes.

Successful health care reform must not be a top-down federal approach but instead one that allows states and individuals to devise health care models that work for them.

Among a few of the principles we would encourage Congress to consider as well:

c Move away from the traditional fee-for-service delivery model toward one based on positive patient outcomes. A 21st-century model encourages patients to be engaged in their own health care and creates incentives for doctors and hospitals when patients get well and less when patients keep returning to hospitals in a revolving-door fashion.

c Advance consumer-directed health care. To empower patients with their own health care, we should reform the tax code to encourage more Americans to set up health savings accounts (HSAs). HSAs would allow consumers to pay for routine medical care, like we do for regular oil changes or tires on a car, and then use high-deductible insurance plans for major medical expenses. That’s the opposite of Obamacare, which taxes and restricts health savings accounts, dealing a blow to consumer-driven health care.

c Stop paying crooks through an aggressive crackdown on criminal activity within Medicare and Medicaid and beef up fraud-prevention programs for state children’s health care plans. Some crooks claim it is more profitable to cheat the government in these programs than to deal drugs. The inspector general thinks nearly 10 percent of Medicare cases are fraudulent. Hundreds of billions of dollars could be saved through better enforcement, whether rooting out nursing homes billing the government for deceased patients or criminals running HIV clinics at the back of pizza parlors.

c Encourage states to enact civil justice reform to prevent frivolous lawsuits that drive up health care costs. A Jackson Healthcare/Gallup physicians poll last year found that $1 in $4 spent on health care is dedicated to unnecessary tests, procedures and drugs that doctors order to prevent being sued. As long as doctors play defense, health care costs will continue to escalate and drive up costs for all of us.

c Create additional federal incentives to ensure nationwide implementation of electronic health records by hospitals, physicians and other health care providers. An electronic platform not only reduces the chance for medical errors in treating patients, but also makes it more efficient and safer to transfer a patient’s history from one provider to another.

These are but a few of the ways we can incorporate solutions that will bring health care into the 21st century, put patients at the center of health innovation and achieve the No. 1 goal of saving lives while saving money.

Nancy Desmond CEO of the Center for Health Transformation where Vincent Frakes is federal policy director for the center.