Focusing solely on health care insurance and the overall national spending on health care will not get us the reform we need. The New England Journal of Medicine recently published a piece by Michael Porter, Ph.D., arguing that true reform requires not just universal coverage, but "restructuring the care delivery system." While the author is, within his own framework, still making a cost argument, he points us toward not just his stated need for a "value-based system," but also toward a "values-based system" rooted in our common human dignity and human right to the highest attainable standard of health.
Dr. Porter argues that "universal coverage in a way that will support, rather than impede, a fundamental reorientation of the delivery system around value for patients" requires six key components:
First, we must change the nature of health insurance competition. Insurers, whether private or public, should prosper only if they improve their subscribers’ health […]
Second, we must keep employers in the insurance system[….] Daily interactions with their workforce enable employers to create value by developing a culture of wellness, enabling effective prevention and screening, and directing employees to high-value providers.[…]
Third, we need to address the unfair burden on people who have no access to employer-based coverage, who therefore face higher premiums and greater difficulty securing coverage […]
Fourth, to make individual insurance affordable, we need large statewide or multistate insurance pools, like the Massachusetts Health Insurance Connector, to spread risk […]
Fifth, income-based subsidies will be needed to help lower-income people buy insurance [….]
Finally, once a value-based insurance market has been established, everyone must be required to purchase health insurance so that younger and healthier people cannot opt out.
Though these key system reforms are being discussed here in the context of "increasing value for patients — the health outcomes achieved per dollar spent," a key shift in Dr. Porter’s article from much of the current discourse surrounding health care system reform is the focus on the health outcomes of the patient rather than on the reduction of the overall spending as a portion of the national Gross Domestic Product. As Dr. Porter points out, change for the better will need to address whether Americans are actually healthier, not simply whether we’re spending less money. We are not consumers of health care; getting a preventative screening, vaccinations, dental care, reproductive care, mental health care, or needed medical operations is not the same as buying a new television. Because our right to the highest attainable standard of health is a prerequisite to living a dignified life, to our productivity, and to our ability to exercise other human rights to food, clothing, and shelter.
The six elements of Dr. Porter’s strategy fit nicely into the framework of our human right to health care. Translated, we can easily see that:
First, we must change the nature of the health care industry. Financing of health care, whether public of private, should first and foremost be dedicated to improving the health of those relying upon them for health care plans; profit-motive should never trump provision of quality and necessary health care.
Second, we must rethink the sites at which health care takes place. Preventative care and wellness efforts should begin where Americans spend most of their days: at workplaces, schools, and community centers. Toward this end, we must be more inclusive in thinking about which institutions are part of the health care system.
Third, we need to address the unfair burden on Americans who have no access to employer-based coverage or to health care plans that are insufficient for needed care, and ensure that everyone has access to appropriate, quality health care regardless of their employment status, where they live, or their health status, gender, or race.
Fourth, we must recognize that health care is a public good, not a commodity, and that we must all share in both the benefits and responsibilities of providing health care for everyone. This means that resources must be used wisely and responsibly, and that the health care financing system should be held accountable for provision of quality care.
Fifth, health care should be available to everyone, regardless of income-level. Health care system reform should include financing based on ideas of fairness and equity; financial contributions should be determined on a sliding scale according to ability to pay, in order to be affordable for all.
Finally, everyone must be part of the health care system for it to be truly universal. High quality and appropriate health care is essential to well-being at all ages, and youth should not be a reason to exclude anyone from both benefiting and contributing to the health care system. When everyone is part of the health care system, and can access and use it in the same way, the system itself is stronger and more sustainable since everyone benefits from supporting it.
A truly reformed health care system is one that is geared toward improving and protecting the health of Americans. Only by looking beyond "value" and toward "values"—such as (true) universality, accountability, fairness and equity, and comprehensiveness—will Americans get the health care that they deserve.
Read more at The Opportunity Agenda’s website.
