Diving Into Health Care Is Dangerous to My Health

If you are anything like me, you have spent the last 10 days listening to President Barack Obama and his Republican challengers accuse each other of being the meanest miser when it comes to denying health care to seniors. Unless you are an actuary or have a fondness for, and facility with, budget math, you were probably left wondering what and whom to believe.

Thats the good news. The bad news is, nothing that has been enacted (the Patient Protection and Affordable Care Act of 2010) or proposed (Republican Representative Paul Ryans Path to Prosperity) addresses the fundamental problem plaguing the U.S. health-care system: It is designed to manage disease rather than promote wellness.

Where do Middle East potentates go when they get sick? The U.S., of course. This country has the highest success rates when it comes to treating disease.

Americas life-expectancy rates, on the other hand, pale in comparison with other developed and developing nations, even though the U.S. outspends them by a huge margin (see below). Imagine what the U.S. could do if it harnessed its resources and talent and focused on disease prevention.

Some communities have already taken the initiative, creating accountable care organizations (ACOs) that use an integrated model for patient care. Cheshire Medical Center/Dartmouth-Hitchcock Keene, for example, introduced Vision 2020 in 2006 with the goal of making Cheshire County, New Hampshire, the U.S.s healthiest community. Cheshire is one of 32 pioneer ACOs selected to test new models of health-care delivery and payment -- paying for results, not volume -- as provided in the Affordable Care Act. Medicare will eventually pay ACOs a lump sum per patient, allowing providers to share in any cost savings compared with traditional fee-for-service plans.

The challenge of saving Medicare from insolvency in 2024 would be easier if seniors had lived healthier lives. It would be a lot easier if the system corrected the perverse economic incentives that reward doctors for unnecessary procedures.

Nothing changes until the people giving the care change the care, says Don Berwick, administrator of the Centers for Medicare and Medicaid Services from 2010 to 2011. That requires redesigning the way care is given into an integrated system, with primary care as the base.

That point is hammered home in an independent film, Escape Fire: The Fight to Rescue American Healthcare, directed by Matthew Heineman and Susan Froemke, an official selection at the 2012 Sundance Film Festival. The documentary combines facts and figures with personal stories from doctors and patients, and innovative ideas from leaders trying to transform the industry.

The film title is a story in itself. It comes from a 1999 speech that Berwick gave at the Institute for Healthcare Improvement, a nonprofit organization in Cambridge, Massachusetts, where he was president. In it, he compares saving the U.S. health-care system to what has become standard practice for fighting forest fires: intentionally setting fire to an area to divert an oncoming blaze. This is known as an escape fire.

The analogy to health care? An out-of-control menace for which there are simple, not easy, solutions.