May 17, 2007
YET "CONSERVATIVES" CHASED THE BEST CONGRESS WE'VE EVER HAD OUT OF TOWN:
Health Care's Retail Solution: A robust retail market is emerging from the ashes of the current health-care system (David Knott, Gary Ahlquist, and Rick Edmunds, 5/15/07, strategy + business)
Imagine a future in which the health-care system provides consumers high-quality care in a variety of convenient forms at competitive prices. In this vision, insurers, employers, and governments offer consumers financial incentives to take better care of themselves — to exercise, eat right, stop smoking, and follow treatment regimens for chronic problems such as asthma and diabetes. The system encourages consumers to plan for the health-care needs they can anticipate (i.e., nonemergencies) by “shopping” for products and services much as they do for a new car; consumers make informed decisions based on readily available reports on quality, service, and price. Providers and product manufacturers compete for different segments of the market using a variety of channels, formats, and business models. And consumers confused by the profusion of offerings can turn to agents who help them design the most suitable health-care programs for themselves and their families.Such a robust retail health-care market is more than a vision; it is a real possibility. Today’s troubled U.S. health-care industry is the result of decades of good intentions and unintended consequences. Payers (defined as government and employers, who foot the bill for most health-care costs) and patients alike struggle to cope with complexity and cost. But most efforts to control costs — by government and by the private sector — have proven unsustainable and have unintentionally increased complexity. The upshot is a situation in which only 61 percent of employers offer coverage for active employees, approximately 30 percent cover retirees, and 46 million Americans are uninsured.
The problem is structural. Major decisions about health care in the U.S. have traditionally been made by employers, who determine for their employees which benefits and forms of coverage are needed, what types of providers are included in the network, and which organizations administer the benefits. But this paternalistic approach effectively allowed the consumer to be a passive participant in his or her own health care. The consumer has had no economic incentive to seek the best care at the fairest price, or to give up unhealthy habits. Limited competition, unclear pricing, inconsistent quality measures, and complex regulations preserve the disconnect among the three major stakeholders in the system — payers, consumers, and suppliers. This last group includes doctors and other care providers, hospitals, and pharmaceutical companies.
Since 2003, however, the situation has come to seem far less intractable than it once did. That year, Congress enacted legislation that could lead to a transformation of the entire U.S. health-care industry from a wholesale to a retail model, in much the same way that retirement plans moved from defined-benefits to defined-contribution schemes. We’re already seeing early signs of a true retail marketplace:
• New health-care formats and competitors are gaining traction, with MinuteClinics and RediClinics — low-cost walk-in health-care centers for common ailments — at one end of the spectrum, and highly personalized “concierge care” at the other.
• Companies that aren’t traditional health-care players are leveraging their capabilities to create entirely new offerings that enable and encourage the move toward health-care consumerism. Fidelity, for example, is developing products and tools that exploit the emerging health–wealth intersection, such as a calculator that helps predict out-of-pocket health-care costs.
• More employers are starting to offer consumer-directed health plans (CDHPs): high-deductible policies that are usually paired with health savings accounts (HSAs) or health reimbursement arrangements (HRAs) designed to help consumers save money that they can use to offset additional health-related expenses whenever they arise.
• In perhaps the single biggest change, the federal government and leading private-sector payers are driving providers to make cost and quality data more transparent so that consumers can make better-informed choices. Standardized data on cost, service, and outcomes has the power to establish a new basis of competition. Payers are also pushing for new payment mechanisms, such as pay-for-performance, that base reimbursement on outcomes or adherence to broadly accepted clinical guidelines, known as “evidence-based medicine.”
These are promising developments, but not all the pieces that make up a true retail market have fallen into place — and those missing pieces represent real opportunity. Drawing on experience and the insights gained from a 2006 Booz Allen Hamilton study of 3,000 consumers and 600 physicians, we are starting to see which factors will enable the system to work well. (See Exhibit 1.) To make competition and innovation among payers and suppliers possible, the system will require the following: consumers who live healthy lives and plan for their future health-care needs; a fundamentally restructured supply side that provides consumers all the information they need to make wise choices and is quick to respond to changing consumer demands; and new kinds of intermediaries (perhaps the payers of today, perhaps not) to help align the supply and demand sides and help consumers navigate the complex system.
The heath care revolution is just one of the arwas where W has built in the mechanisms that will boost his reputation over the coming decades. Posted by Orrin Judd at May 17, 2007 12:21 PM
W's resume:
Attacked and took over two countries.
Spent the surplus and bankrupted the treasury.
Shattered record for biggest annual deficit in history.
Set economic record for most private bankruptcies filed in any 12 month period.
Set all-time record for biggest drop in the history of the stock market.
First president in decades to execute a federal prisoner.
First president in US history to enter office with a criminal record.
First year in office set the all-time record for most days on vacation by any president in US history.
After taking the entire month of August off for vacation, presided over the worst security failure in US history.
Set the record for most campaign fund-raising trips than any other president in US history.
In my first two years in office over 2 million Americans lost their job.
Cut unemployment benefits for more out of work Americans than any president in US history.
Set the all-time record for most foreclosures in a 12 month period.
Appointed more convicted criminals to administration positions than any president in US history.
Set the record for the least amount of press conferences than any president since the advent of television.
Signed more laws and executive orders circumventing the Constitution than any president in US history.
Presided over the biggest energy crises in US history and refused to intervene when corruption was revealed.
Presided over the highest gasoline prices in US history and refused to use the national reserves as past presidents have.
Cut healthcare benefits for war veterans.
Set the all-time record for most people worldwide to simultaneously take to the streets to protest me (15 million people), shattering the record for protest against any person in the history of mankind. (http://www.hyperreal.org/~dana/marches/)
Dissolved more international treaties than any president in US history.
My presidency is the most secretive and un-accountable of any in US history.
Members of my cabinet are the richest of any administration in US history. (the 'poorest' multi-millionaire, Condoleezza Rice has an Chevron oil tanker named after her).
Had more states to simultaneously go bankrupt than any president in the history of the United States.
Presided over the biggest corporate stock market fraud of any market in any country in the history of the world.
Created the largest government department bureaucracy in the history of the United States.
Set the all-time record for biggest annual budget spending increases, more than any president in US history.
First president in US history to have the United Nations remove the US from the human rights commission.
First president in US history to have the United Nations remove the US from the elections monitoring board.
Removed more checks and balances, and have the least amount of congressional oversight than any presidential administration in US history.
Rendered the entire United Nations irrelevant.
Withdrew from the World Court of Law.
Refused to allow inspectors access to US prisoners of war and by default no longer abide by the Geneva Conventions.
First president in US history to refuse United Nations election inspectors (during the 2002 US elections).
All-time US (and world) record holder for most corporate campaign donations.
My biggest life-time campaign contributor presided over one of the largest corporate bankruptcy frauds in world history (Kenneth Lay, former CEO of Enron Corporation).
Spent more money on polls and focus groups than any president in US history.
First president in US history to unilaterally attack a sovereign nation against the will of the United Nations and the world community.
First president to run and hide when the US came under attack (and then lied saying the enemy had the code to Air Force 1)
First US president to establish a secret shadow government.
Took the biggest world sympathy for the US after 911, and in less than a year made the US the most resented country in the world (possibly the biggest diplomatic failure in US and world history).
With a policy of 'dis-engagement' created the most hostile Israeli-Palestine relations in at least 30 years.
Fist US president in history to have a majority of the people of Europe (71%) view my presidency as the biggest threat to world peace and stability.
First US president in history to have the people of South Korea more threatened by the US than their immediate neighbor, North Korea.
Changed US policy to allow convicted criminals to be awarded government contracts.
Set all-time record for number of administration appointees who violated US law by not selling huge investments in corporations bidding for government contracts.
Failed to fulfill my pledge to get Osama Bin Laden 'dead or alive'.
Failed to capture the anthrax killer who tried to murder the leaders of our country at the United States Capitol building. After 18 months I have no leads and zero suspects.
In the 18 months following the 911 attacks I have successfully prevented any public investigation into the biggest security failure in the history of the United States.
Removed more freedoms and civil liberties for Americans than any other president in US history.
In a little over two years created the most divided country in decades, possibly the most divided the US has ever been since the civil war.
Entered office with the strongest economy in US history and in less than two years turned every single economic category heading straight down.
Jesus, I only made it about halfway through that pathetic laundry list but it is already one of the stupidest things I've ever read. Honestly, the quality of trolls around here has declined in recent months. I'll leave it to my elders and betters to give it a proper fisking.
Posted by: Bryan at May 17, 2007 1:23 PMHe didn't create the divide, it was already there.
You're just pissed the final takeover's been delayed.
Dems could have worked w/him any time they wanted to, they chose not to.
Do we need to review how stupid Daschle looked?
As to the economy, someone doesn't remember "irrational exhuberance," Y2K and 9/11.
As to the deficit, should be paid off by 10/08 if we're lucky.
As to Sork, the young are always foolish, let them join together, they'll learn.
Posted by: Sandy P at May 17, 2007 4:14 PMI'll look forward to the sequel.
Posted by: erp at May 17, 2007 4:19 PM-- Major decisions about health care in the U.S. have traditionally been made by employers, --
And states.
Posted by: Sandy P at May 17, 2007 6:52 PMWe don't have to rebut each item on gupta's list. Just consider the first one - isn't the Number One Democrat complaint that we have not and cannot win in Iraq? So, in saying "took over", he betrays himself. As for the rest, the illogic and untruth are manifest.
Posted by: jim hamlen at May 18, 2007 6:39 AMRebut them? They're generally right. We just favor what he opposes.
Posted by: oj at May 18, 2007 9:10 AM