I want to commend you on this well thought out discussion of the some of the important issues facing our health care system- and how they might be addressed. However, as you state, "Success would require sustained commitment and coordination across multiple stakeholders, including government agencies, health care providers, insurers, and the public."
In my opinion, it will be very difficult to accomplish this coordination without an agency or body that has oversight of the many disparate interests in our system- a body like the Federal Reserve Board.
The Fed was created in 1913 to help coordinate reform of the US banking and financial system which up to then suffered from many of the same issues that currently affect our health care system. I believe that this is the only way we can tackle the issues that you raise (and many more).
I discuss this idea of creating a health care version of the Federal Reserve System in my book: "Building a Unified American Health Care System: A Blueprint for Comprehensive Reform"
Absolutely agree that governance and the management of sweeping reform will be important. In theory, the U.S. Department of Health and Human Services should be performing these tasks, but the issue first comes down to the authorities granted by Congress. I look forward to reading your book! I do think that more careful evaluation of how public health systems and medical care systems can integrate is a good approach that has been gaining speed. However a big barrier is that the Congressional Budget Office cannot include the downstream cost reductions of better health in their scores of new policies.
Thanks for the quick reply and for your interest in the book.
As I discuss in the book, HHS does not really have the oversight of the private sector and, as you mention, is beholden to Congress (which can be quire fickle). In addition, there is the fact that HHS is a Cabinet department, so it is overseen by and answers to the POTUS.
This is exactly the problems that the US financial system had at the turn of the 20th century- a powerful private sector (the banks) and an overly politicized Department of the Treasury that was also beholden to both POTUS and Congress. The solution was the creation of the Federal Reserve system overseen by economist rather than politicians and bank executives.
We can use this model to create a National Medical Board (the name can be changed) that oversees both the commercial and public health care system. It would be led by physicians, health care economists and public health experts instead of politicians and health insurance executives...
I completely agree that political oversight should be removed from the equation and that an independent board would function better if lobbying interests could be prevented from gaining control. The provisions concerning the U.S. Preventive Services Task Force under the Affordable Care Act are a small step toward independent board control of both public and private sector coverage policies. Mandating coverage of preventive services with an A or B rating across all insurers is an interesting model that could be expanded to other functions in health. I generally think that the biggest issue in the private sector is market consolidation, so the answer to that is either very aggressive “trust busting” (which is nearly politically impossible) or a model like you suggest where there is centralized coordination, price and coverage regulation, and universal coverage provisions. I always refer back to Gerard Anderson at JHU in that the problems are still “the prices.” The only way to get them down is to either truly increase competition and consumer choice (which is almost impossible mechanically) or to regulate them centrally.
Although I agree that prices are a problem, I think it is important to understand that health care economics doesn't work the way other economics work. Although competition may improve quality (especially among hospitals) it rarely reduces prices or costs. This also seems to apply to Pharma.
The problem is that there are misaligned incentives that are built into our current system that cannot be reformed from within. Again, I discuss this in more detail in my book.
I want to commend you on this well thought out discussion of the some of the important issues facing our health care system- and how they might be addressed. However, as you state, "Success would require sustained commitment and coordination across multiple stakeholders, including government agencies, health care providers, insurers, and the public."
In my opinion, it will be very difficult to accomplish this coordination without an agency or body that has oversight of the many disparate interests in our system- a body like the Federal Reserve Board.
The Fed was created in 1913 to help coordinate reform of the US banking and financial system which up to then suffered from many of the same issues that currently affect our health care system. I believe that this is the only way we can tackle the issues that you raise (and many more).
I discuss this idea of creating a health care version of the Federal Reserve System in my book: "Building a Unified American Health Care System: A Blueprint for Comprehensive Reform"
(https://www.press.jhu.edu/books/title/12954/building-unified-american-health-care-system)
Absolutely agree that governance and the management of sweeping reform will be important. In theory, the U.S. Department of Health and Human Services should be performing these tasks, but the issue first comes down to the authorities granted by Congress. I look forward to reading your book! I do think that more careful evaluation of how public health systems and medical care systems can integrate is a good approach that has been gaining speed. However a big barrier is that the Congressional Budget Office cannot include the downstream cost reductions of better health in their scores of new policies.
Thanks for the quick reply and for your interest in the book.
As I discuss in the book, HHS does not really have the oversight of the private sector and, as you mention, is beholden to Congress (which can be quire fickle). In addition, there is the fact that HHS is a Cabinet department, so it is overseen by and answers to the POTUS.
This is exactly the problems that the US financial system had at the turn of the 20th century- a powerful private sector (the banks) and an overly politicized Department of the Treasury that was also beholden to both POTUS and Congress. The solution was the creation of the Federal Reserve system overseen by economist rather than politicians and bank executives.
We can use this model to create a National Medical Board (the name can be changed) that oversees both the commercial and public health care system. It would be led by physicians, health care economists and public health experts instead of politicians and health insurance executives...
I completely agree that political oversight should be removed from the equation and that an independent board would function better if lobbying interests could be prevented from gaining control. The provisions concerning the U.S. Preventive Services Task Force under the Affordable Care Act are a small step toward independent board control of both public and private sector coverage policies. Mandating coverage of preventive services with an A or B rating across all insurers is an interesting model that could be expanded to other functions in health. I generally think that the biggest issue in the private sector is market consolidation, so the answer to that is either very aggressive “trust busting” (which is nearly politically impossible) or a model like you suggest where there is centralized coordination, price and coverage regulation, and universal coverage provisions. I always refer back to Gerard Anderson at JHU in that the problems are still “the prices.” The only way to get them down is to either truly increase competition and consumer choice (which is almost impossible mechanically) or to regulate them centrally.
Although I agree that prices are a problem, I think it is important to understand that health care economics doesn't work the way other economics work. Although competition may improve quality (especially among hospitals) it rarely reduces prices or costs. This also seems to apply to Pharma.
The problem is that there are misaligned incentives that are built into our current system that cannot be reformed from within. Again, I discuss this in more detail in my book.