Delivery System Day: Henry Aaron
Henry Aaron -- or Hank Aaron, as he's called -- is a senior fellow at the Brookings Institution and an expert on the economics of health care. He's also one of my favorite reality checks: About as far from an gauzy optimist as you can get, Aaron tends to give it to you straight. Here's his take on the health-care reform's most important, but little-known, priority:
Analysts -- right, left, and center -- agree that integrated delivery systems, exemplified by the Mayo Clinic, deliver high quality of health care at lower cost than do individual physicians and hospitals delivering uncoordinated care under the fee-for-services system. They all agree that care would improve and growth of spending might be at least temporarily slowed if typical patients, especially those suffering from multiple or complex conditions, received care from organizations that emphasized Mayo’s team-based approach to care and that used modern information technology. They would do even better if they had available a rich library of comparative effectiveness research -- a library far larger than can be created with the modest funds contained in the economic stimulus bill passed earlier this year.
Yet, no one has a very good idea how to foster and accelerate the emergence of such organizations. The draft health reform bills contain proposals for demonstrations or pilots of new payment systems. Even if these pilots and demonstrations work optimally, it will be many years, even decades, before entrepreneurial hospital administrators and physicians make integrated health care systems a reality for most Americans. The simple fact is that transforming the delivery system will be a long, hard slog. Every responsible analyst knows how hard and how central this problem is, but it is not clear what more legislation can do at this point.
Quick Hank Aaron story before we end this post: As you might have noticed, he shares a name with a certain famed baseball player. For years, a letter hung in the Brookings elevator asking Aaron if he couldn't sign a ball and send it to a charity auction somewhere. Rumor has it that he signed a copy of his report "The Peculiar Problem of Taxing Life Insurance Companies" instead.
Photo credit: Courtesy of Brookings.
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