Letters to health-care Santa: Competition for care, not just insurance
Over the course of this week, I'll be asking some health-care experts what they'd like Santa to add to the bill during conference committee, and publishing their responses on the blog. Next up is George Halvorson, chairman and chief executive of Kaiser Foundation Health Plan Inc. and Kaiser Foundation Hospitals. Kaiser Permanente is the nation’s largest nonprofit health plan and hospital system, serving more than 8.6 million members and generating $40 billion in annual revenue.
If I could add one thing to the bill, I would make the exchanges more robust and require them to provide consumer focused data about care team choices and performance. It can be done if it is designed into the exchange requirements. When your chance of dying within five years from late stage prostate cancer ranges from thirty percent to almost seventy percent depending on the care team you select, and when your chance of dying from major heart surgery varies by a multiple of twelve -- also depending on your care team -- we clearly need consumers to be able to make much better informed choices about care and the teams who deliver care.
The exchanges as designed in the current bill deal with health plan choices only. That is a wasted opportunity. The future health plan marketplace for America should be about dueling care teams, not dueling actuaries. Let's not miss this chance to transform care by building the exchange model with components that help consumers make smart choices. Insurance competition is good. Care team competition is better. Exchanges should have low barriers to entry for accountable health systems and high standards for important data about care outcomes and successes. It's not too late to go down that path. The entire bill can point us in a direction that facilitates care delivery reform as well as insurance reform. We need both.
Earlier in this series, Diane Archer called for Congress to create national exchanges rather than state exchanges, Alain Enthoven offered some ideas for how to fix the exchanges, David Cutler proposed a soda tax, Austin Frakt argued for competition in the Medicare Advantage program, and Jacob Hacker broached letting the public sector help the private sector negotiate lower rates.
December 22, 2009; 5:30 PM ET
Categories: Health Reform
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