Newtown, CT – October 26, 2012
How do we avoid continuously committing the seven deadly policy sins that undermine our ability to deliver the noble mission of health care? In an article this week Julie Appleby lists the seven factors driving up healthcare costs. They are: (1) paying for volume rather than value (greed); (2) an increasingly unhealthy population (gluttony); (3) desire for new technologies and drugs (envy); (4) tax breaks on insurance premiums (sloth); (5) lack of transparent information (pride); (6) provider consolidation driving higher prices (lust); and (7) legal and regulatory barriers (wrath). To a very large extent, these factors are simply a reflection of bad policy that is, in some part, motivated by the seven deadly sins. The wrath of the wronged patient seeks a malpractice settlement; the lust of the hospital for more market power drives consolidation; the pride of providers and payers is better served by ignorant consumer-patients; the inertia of policymakers to deal with antiquated tax deductions keeps us from righting wrong incentives; the envy to have the latest stuff drives demand for unneeded services; our collective gluttony has led to rampant chronic problems; and the greed generated by volume-based payment overwhelms the system. How do we break away from these sinful ways? One step at a time, like Walmart is doing. By taking the important step of contracting for value with a select number of providers to offer better quality care to its associates, at a lower cost, providing those associates with transparent and actionable information, a few of the deadly policy sins are blocked in one step.
What this means to you – While we might not be able to individually change the tax code to eliminate the corporate tax deduction on health care insurance, nor change the malpractice statutes, we can affect change collectively. And many of the other policy sins listed above can be avoided by refusing to continue to commit them. Employers must take a leading role. For example, stop penalizing healthy foods in company cafeterias, and price the burgers and fries at $10 and the salads at $2.50, not the other way around. Disseminate complete, timely and transparent information on the cost of medical episodes of care and the quality of the providers delivering them. Break up the provider consolidations by forcing competition at the service line/episode level. And stop rewarding volume. There's a reason they're called deadly sins, and Lord knows they've wreaked misery on many. We're the ones committing them, and only we can stop. So to help you on your daily journey, I've compiled past musings into a freely downloadable ebook. And when you're feeling down, defeated, or frustrated, read a few passages and get mad instead, because anger at these policy sins is the best way to defeat them.
Francois de Brantes
Health Care Incentives Improvement Institute, Inc.