Letter to the President

I penned the following letter in September of 2008, prior to the elections and the truly heated rhetoric on the healthcare debate really got going.  The letter was my regular column for "To Your Good Health: A Healthcare Newsletter" and I came across it today while preparing for my next edition.  It is disappointing how few of my suggestions have been followed...I am under no illusion that policy makers would review my letter, rather I thought the suggestions were common sense solutions and a practical framework for decision making within healthcare reform - alas it has not proven to be so.

I think it remains an interesting read and another way to think about what has been missed in the proposals that are currently languishing their way towards 2010 in the Congress and Senate.

An Open Letter to the 44th President of the United States (September 2008, To Your Good Health)

There are a litany of challenges facing your administration, healthcare being but one of them; but few issues have the long reaching political, financial, and social ramifications that repairing our healthcare system has. Few prominent politicians have demonstrated the political will to stand up and provide true leadership on the US Healthcare system, there are some notable exceptions, but the vast majority have avoided tackling this challenging issue in any meaningful way. For good reason, it does not represent an expedient political victory but rather is comprised of numerous competing agendas, strong lobbyists, a juggernaut of various patient advocacy groups, and some very powerful corporations working to keep the status quo in place.

Fundamental to any discussion on improving the healthcare infrastructure in the US is to mitigate the unfettered inflationary pressures on healthcare costs, which have taken a greater share of per-capital GDP than any other country and which continue to negatively impact our global competitiveness. A reduction in waste, rather than a reduction in services, should be the preferred method to achieve a reasonable level of cost containment, but we have tried and failed before to mitigate the overall rise in the cost of healthcare; we need to look at the “back-office” functions within the system, begin utilizing more sophisticated technologies, which are commonplace in other industry sectors, and work towards reducing non-clinical spending within the healthcare sector; producing a more efficient healthcare system will drive up the percentage of overall spending which is tied to clinical care, reduce non-clinical (administrative) expenditures, and give us a greater return for our invested healthcare dollar.

Additionally we need to look at the overall spending and incentivize care delivery in the most cost efficient settings, leaving the higher cost environments free to provide high quality care for those patients who require it. There are a number of challenges here as well; just look at the over-utilization of ER services, the resulting excess costs and losses, and try to balance solving that problem against a picture of fewer primary care doctors available to deliver care in a lower cost setting, a dwindling supply of qualified nurses, and a serious capacity issue with alternative site care. What becomes clear as you examine any part of the domestic healthcare challenge is that its an incredibly complex challenge, but one which needs leadership, intelligence, and creativity to try and solve; there is no silver bullet here, no easy fix or adjustment which can snap us out of the current crisis – it will continue to take broad approach, strong leadership, and detailed study, but it must be prioritized.

Cost reductions must come from all areas, and consumers must play a more pro-active role in their own healthcare if we are to solve the problem as a country; that means being an engaged patient, and also making the necessary lifestyle changes to reduce risk of chronic health conditions. A healthy lifestyle is the first step in reducing our personal risk for health complications, and in the macro-picture it’s our country’s best hope of reducing overall healthcare expenditures in the longer term.

I hope as our next President you can make the difficult decisions necessary, provide the strong leadership this crisis calls for, and work diligently to ensure our healthcare infrastructure remains the worldwide destination for care, while creating a more fiscally manageable program for our residents and businesses.