Welcome to the HCD Archives


Welcome to Health Care Disconnects: A Reform Perspective. We hope that you will find this an interesting, timely and useful source of information and perspective on the challenges facing health care in America today. Our focus is not only on problems but also directions toward solutions that are based on experience and evidence from health policy research in this country. We will also seek to comment on experience from other countries to the extent that it may be useful in this country.

Why Health Care Disconnects?     

We believe that there are widespread misperceptions and misunderstandings about the realities of our current health care system and the presumed “reform” initiatives that we are told will “fix” our problems. Some of these initiatives have already been proven to be policy failures over more than thirty years. Although the Affordable Care Act (ACA or ObamaCare) will increase access for many Americans, its provisions will be largely gamed by the insurance industry and other purveyors of health care services. Its goal of affordable health care will be found to be illusory while profiteering at patients’ and their families’ expense continues unabated.

Here are just two of the many obvious disconnects between attempted “reforms” and reality that illustrate some of the directions this HC-D forum will take:

•  Much of the increased access that will occur through the ACA will be by expansion of Medicaid; but many states are opposing such expansion, coverage will vary widely by state and be inadequate in most, reimbursement will be so low that  a majority of physicians will not see Medicaid patients, and the increasing shortage of primary care providers will not be relieved.

•  The ACA did not acknowledge that most of the problems of our present “system” are due to failure of an open market to limit its excesses in the public interest; instead of dealing with that, the ACA subsidizes a failing private health insurance industry, sets up a vastly more complex bureaucracy in an effort to keep that industry alive, has no mechanisms to contain prices, and restricts the role of a national scientific body from recommending reimbursement and coverage policies based on their efficacy and cost-effectiveness.

Toward Re-Connecting our Health Care System

The scope of needed reforms is wide since there continues to be an enormous gap between a system of universal access that we would like to see and the realities of barriers to access, unaffordable costs, variable quality, disparities and inequities facing ordinary Americans across the country. We need a Copernican shift from the present multi-payer market-based system driven by corporate money and special interests to one based primarily on the needs of patients and their families.

The breadth of needed reform is suggested by these elements of this kind of paradigm shift:

•  Moving from a system based on ability to pay to one based on medical need, without first-dollar cost-sharing.

•  Moving from a fragmented and exploitive private health insurance industry to a single publicly-financed risk pool.

•  Moving from profits driven by a business “ethic” to a not-for-profit system based on service.

•  Moving from a volume-driven fee-for-service payment system to one where physicians are primarily salaried.

•  Moving from political and lobbyist-driven coverage and reimbursement policies toward those based on scientific evidence of efficacy and cost- effectiveness.

• Developing electronic medical records with the capacity to efficiently and reliably transmit medical information within all part of the health care system without today’s barriers of “customized” record systems that don’t talk to each other.

•  Replacing today’s unaccountable system with one that stewards limited health  care resources for the benefit of all Americans (“Everybody in, nobody out.”).

Although this list of reforms sounds daunting and perhaps impossible, we believe that the present dysfunctional market-based system is imploding. It will have to be put back together in fundamentally new ways, starting with shifting to single-payer public financing coupled with a private delivery system. That very change will involve shifting from fee-for-service to negotiated payments to physicians and other health care professionals as well as global budgets for hospitals and other facilities. Bureaucracy will be vastly decreased and new efficiencies can be achieved in a more accountable system oriented primarily to the needs of patients.

Our current health care non-system is unsustainable. It is imploding due to soaring costs that are increasingly unaffordable for most Americans. Access to care is inadequate, profiteering is rampant in a volume-driven, mostly fee-for-service payment system, quality is variable, often mediocre, and health outcomes for our population are much worse than other industrialized nation.

There is already enough money in health care to rebuild a system of universal health care that will be sustainable. Other countries have done it. We can too. Chapter 12 of my recent book, Health Care Wars: How Market Ideology and Corporate Power Are Killing Americans, lays out the scope and a strategic plan for accomplishing that objective. 

Along the way, we welcome postings from all involved in reading our blogs. We need an honest sharing of ideas concerning problems and solutions as we work toward a new system that best fits traditional American values—efficiency, choice, affordability, fairness, and accountability—in a way that is fiscally responsible and sustainable.