The State of Our Union’s Health

I was a bit disappointed that the President did not spend more time discussing health care in his State of the Union address last week. I hope people listening did not conclude that the issue is dramatically less important than addressing terrorism, improving education or reducing dependence on foreign oil. The points the President did emphasize about personal ownership and responsibility for one's own health care underpin the details of his health care policy. Those details will be discussed and debated over the next several months in a manner that I hope will fully inform consumers about their important role in consumer driven health care.

An essential concept that fits well with the President’s other themes is the idea of consumer driven health care – in which patients take a great deal of responsibility for their medical choices, but also have substantial opportunity to make sure they are getting the right care for themselves. Over the next few years, a great many Americans will find themselves in a position of increasing choice and with unprecedented information to guide their health care decisions. Consumer driven health care has already begun to activate as is made clear by the numbers of people taking advantage of health savings accounts – a trend that will undoubtedly continue and accelerate. At the same time, many insurers are making moves to encourage patients to take a more active role in choosing health care solutions for their health conditions.

What we are talking about is a movement in which patients take responsibility for finding and choosing the best health care options for them. They will gain a new level of power and control in health care. Expanding HSAs is one way that this will happen. In the past, patients have not known the costs associated with medical care they need. Negotiations went on between doctor and insurance company, and the patient just thought of health care costs as whatever their copay was. In the future, patients will have greater responsibility for their own health care spending. They will also have much more information at their fingertips. A big part of this information is going to be data on quality of care.

I have had a long career of pushing for transparency in health care and encouraging personal responsibility in public health. These things are coming together in the consumer driven health care movement and they are reflected in many of the quality improvement and educational efforts we are working on at UNC. And so, that may be a long answer to the question of whether the President addressed health care adequately last week- I mean to say that he did so in the same themes that apply to the other issues he raised – we all have a responsibility to be engaged, not to put our heads in the sand, and to take responsibility for shaping America’s future. Consumer driven health care is a great opportunity to model these values.

1 thought on “The State of Our Union’s Health

  1. Bruce Wicks

    Thank you for creating this new opportunity to communicate about so many important issues that affect our community and our families.

    Regarding the issue of consumer driven healthcare, I have had some recent personal experience here at UNC that was eye opening that I would like to share.

    I have recently moved here from another academic medical center that has a comparatively rich health insurance benefit package that has covered virtually all of our family’s considerable healthcare costs over the years. Having just been evaluated and hospitalized over night here for the evaluation of chest pain, I am now looking at bills that I have never experienced before. As a result, I am cancelling some of the further (very expensive) evaluations that have been recommended by my physician based purely on my ability/desire to pay. Similarly, my wife is now delaying evaluations of some continuing potentially serious health issues based on the financial impact it may have on our family.

    I relay this information to convey to you that this type of decision making is real, albeit less than ideal, in terms of preventing future, potentially serious and very expensive health problems and that it should be considered when the initiative begins to more fully develop HSA’s.

    My wife an I are, what I consider to be, very sophisticated healthcare consumers. Given our careers of 30+ years in healthcare, we feel that we can make relatively informed decisions about what types of interventions we need, but much of the population of this country is not in that position. They may be precisely the wrong people to be making these decisions, especially when they will be balancing them against the other financial priorities of their families. To make the HSA system really work, this is going to require a much more effective communication/negotiation process between patients and their physicians and should not be viewed as simply a new financial mechanism to share the pain and reduce costs. It will also require a far more informed public than we currently have and a change in physician behavior away from ordering that additional test or procedure that may be only marginally helpful. While consumer driven healthcare may be the way to make significant changes in our healthcare system, it should be designed with the decision making abilities of the public in mind and not just as a mechanism to ration healthcare.


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