Lessons From Abroad for Health Reform in the U.S.

I attended the Galen Institute’s valuable Lessons From Abroad for Health Reform in the U.S. program today. The conference materials are available here.

At the conference I heard an informative lecture on US health care reform by Emory University Prof. Kenneth Thorpe. He broke health care reform into three components — 1) primary care / prevention 2) redesigning the delivery infrastructure, and 3) covering the uninsured. He described the first two issues as bipartisan health care reform issues and the third as the hot potato reimbursement issue.

With respect to the first and second components, Prof. Thorpe explained that the U.S. has the best tertiary care health system in the world which is funded by a reimbursement system that is tilted toward paying for tertiary care. He asserted that the U.S. must devote more resources toward prevention, e.g., reducing obesity, and refocus the delivery structure from tertiary care to caring for the chronically ill, e.g. the obese, depressed, hypertensive diabetic. He explained that caring for the chronically ill requires teams of non-MD care coordinators. I think that the FEHB Program is ahead of the curve on these issues.

With respect to covering the uninsured, Prof. Thorpe noted that both AHIP and Phrma favor an individual mandate similar to that found in Sen. Baucus’s reform white paper. How do you pay for it? The President budget includes a reserve of $634 billion to cover the uninsured. But the 10 year cost is projected at $1 trillion. (Projections vary of course) Consideration is being given to tax changes and employer play or pay. Other hot button issues include the availability of a public plan option and the cost effectiveness institute that was funded by ARRA.

According to the Congressmen who spoke (both Republicans Dr. Tom Price and Dr. Michael Burgess), the leadership hopes to enact a comprehensive health care reform law before the August recess. Both Congressmen spoke of using the FEHBP as a model for a national health insurance exchange.