Reform strategy from Harvard's greatest minds

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The American health care system seems in an accelerating downward spiral:
wasteful, unsustainably costly, inadequate in quality, and unable to protect millions against the financial burden of illness.

The Harvard Forums underscored the important notion of local communities functioning as laboratories for innovation and testing, assessing what does and does not work before broader adoption.

The authors offer a vision that is sufficiently challenging to encourage our most thoughtful, creative efforts, and also sufficiently realistic to be attainable. They propose a set of steps over a twenty-year period that will put our nation on a course towards a health care system that assures universal health insurance coverage to all Americans, provides optimal quality of care, is affordable, assures improvements in population health, and provides the greatest possible value for health care expenditures.

Stage One - Strengthening and Leveraging Existing Efforts

In this model, state and local governments will act as regulatory enablers, while private stakeholders - large anchor corporations, local health plans, major health care providers, unions, consumer groups - will provide leadership and expertise to launch local health care reform.

Specifically, over the next five years, this strategy advocates strengthening the tax credit and health savings account (HSA) approaches through careful elaboration of all the options and developing devices to mitigate possible unintended consequences and by evaluating these programs to see how well they perform in terms of reaching coverage, population health, and cost goals.

Stage Two - Phasing in a Federalist Approach to Reform

State plans must commit to achieving quantifiable, five year goals for expansion of health insurance coverage, and at least one other domain of the vision outlined above (e.g., quality, affordability, value, population health). (Don’s comment: Note that this does not require universal coverage, and, besides, which three goals would you decide to omit?)

…goals might stipulate…

…goals might include…

…states might propose…

…states could focus…

…States could put in place…

…States could take steps…

…states could undertake…

…(etc., etc.)…

Stage Three - Implementation of State-Based Programs throughout the United States

States that come late to the health care reform table will have the benefit of 15 to 20 years of systematic experimentation with local and state level health system reforms addressing the nation’s most fundamental health care problems. Those experiments will have been carefully evaluated, the results published and thoroughly vetted, and the strategies themselves will have become familiar to the American people. A cadre of experienced health policy leaders will exist in both the public and private sectors that can testify to the strengths and weaknesses of alternative approaches, and will be available to implement change throughout the United States. In other words, the intellectual and human capital necessary for effective change will be ready and waiting for a more comprehensive effort at health system change, whatever form that effort ultimately takes. We further expect that this eventual program of reform will continue to rely heavily on state management, will provide considerable autonomy to state government, and will consist of varied solutions to common problems across the United States.

Conclusion

Policy-making, like politics, should be viewed as the art of the possible.
The current climate cries for action, but the political climate determines the form such action can take. We believe that the program we have outlined will improve the lives of Americans in ways that foster learning, prepare us for all eventualities, and precludes no options as changes in our health care system unfold over the next twenty years.

Harvard University Program for Health Systems Improvement http://www.phsi.harvard.edu/

A Strategy for Health Care Reform: Catalyzing Change from the Bottom Up http://www.phsi.harvard.edu/pdfs/reform.pdf

Comment:

By Don McCanne, M.D.

Wow!

Some of the greatest minds at Harvard University have been given five years to produce a report providing us with a strategy for health care reform in the United States. While acknowledging the profound deficiencies in our very costly system, these geniuses have proposed that we sit around for another two decades waiting to see if someone can do something on the state or local level. Just what do they think the states and counties have been doing during the past century of federal inaction? And tax credits and health savings accounts? We need to bring them out of their closets!

If a freshman Harvard student were to produce this paper in response to an assignment on proposing a strategy for health care reform, the instructor would certainly grade it with an “F” as being totally non-responsive to the assignment.