Software product development is both art and science; creative and technical. Despite what one might think, though, it is rare for software engineers to begin from scratch. Most software is developed within or on top of an established framework, as enhancements to operational systems, or morphing existing software into something new. The point is technologists don't solve problems by reinventing the wheel. It is from this perspective I offer some ideas and areas of potential change and compromise on ways to fix our health care system.
Free market. Last month I wrote about this from a personal/consumer point of view and that, as with other rational markets, consumers can make rational decisions. What continues to amaze me is that our largest industry (government doesn't count) does not operate on real, open market principles. To move in this direction we should empower and educate consumers by focusing on consumer-driven health plans, defined employer contribution models, lower premiums for improved health outcomes and proper disease management, and medical procedure cost transparency. We need to also provide quality of service information so consumers can stop making the assumption that higher prices equate to better quality.
Essential benefits. Lower the threshold for essential benefits. Do something similar to what states do with car insurance, where they don't mandate collision insurance, for example. If you're driving an old clunker you can choose minimal coverage that doesn't include collision; or if you're young and don't plan on seeing a doctor you're only required to get minimal health insurance coverage. This addresses two issues: First, the high cost of catastrophic events that go unpaid because of the lack of insurance and, second, the potential stress on the limited number of providers by better controlling the number of people entering the health care system.
High risk pools. PPACA established temporary high-risk pools until the health insurance exchanges come online in 2014, at which time people in the high-risk pools would move into the exchanges. Maybe a better idea is to continue utilizing high-risk pools. This may help mitigate the adverse selection dilemma faced by exchanges.
Medical malpractice. Defensive medicine, the practice of ordering extra tests and procedures to protect against potential lawsuits, results in excessive spending. According to Patients for Fair Compensation, "up to $650 billion per year in defensive medicine practices" could be eliminated by fixing (or replacing) the malpractice litigation system.
Medicaid. Seemingly glossed over in the recent Supreme Court decision on health reform, the Court ruled 7-2 against mandating states expand Medicaid or lose their funding. Constitutionality aside, most states were seriously concerned about the impact of moving up to 30 million people into Medicaid, an already overburdened system. This has to be fixed and is quite complicated but, coming full circle back to my first idea, empowering citizens to become educated consumers should be the basis for any Medicaid solution.
Like I've done in my 30-plus years in software development, I'm trying to approach health reform from a problem solving perspective and get the redesign juices flowing. If your strategy was hoping that the Supreme Court would find the Patient Protection and Affordable Care Act unconstitutional, then I would tell you what I tell my sales team: Hope is not a strategy.
Lamb is VP and group head of the EbixBenergy business unit at Ebix Health in Atlanta. Reach him at email@example.com.
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