More than 200 students, faculty and community members gathered to hear former Tennessee Gov. Phil Bredesen discuss his thoughts on meaningful health care reform, as part of the Vanderbilt University School of Nursing Centennial Lecture Series. His take-away message: Members of the health care community, not just elected officials, have responsibility to help solve the health care problem.
“I really do believe medical centers like Vanderbilt ought to be leading the discussion in the country,” said Bredesen. “It’s a nonprofit organization, with and headed by some very smart people … and I would much rather the people standing within 500 yards of me now do the fixing than a bunch of accountants or management consultants or someone else operating out of a K Street office in Washington.”
The problem, according to Bredesen, is that in the U.S. “if you have health insurance, the purchase of health care is extremely inelastic. The cost of a procedure, the cost of a drug, the cost of services in that system has little to do with whether it’s consumed or not.
“We have the logical and perfectly foreseeable result of the payment system, the economics of which we’ve adopted for health care,” he added. “If we see that as a core issue, we can work to find solutions.”
Bredesen focused his comments on what he called the broad shapes of the health care issues in our county.
Under the Affordable Care Act, he expects health exchanges will transform how health is delivered because there will be a substantial decline in employer-based insurance that will have cost and innovation implications. He also shared his concerns about how to pay for the new law.
“The biggest shape in reform is one that isn’t there,” he said. “If you believe it’s all about the economics, you need to find better ways of financing the delivery of health care, and I do not see a robust quality assurance structure.”
He believes that the health care industry needs a set of quality standards – measuring techniques in real time to see if standards are being addressed. Bredesen provided examples of certain illnesses, like diabetes, with wide treatment protocols, and other illnesses with little or contradictory treatments. He cautioned that quality assurance is not about counting visits, but about assessing the individual care.
“It’s hard to believe that setting quality standards by doctors, nurses and medical field professionals would not transform process for the better,” he said.
As far as future reforms, he would like to see a health care system that provides a base level of care as a right of citizenship. He believes health care has to be delivered through some system of care that eliminates silos and balances cost of care appropriately with objective and public quality measures. He also would like to see a strong quality assurance system with public results so customers can “vote by their feet.”