Reflections on Health Reform – Again

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2. Reflections on Health Reform - Again
July 30, 2009
Anthony Kovner, M.P.A., Ph.D.
Professor of Public and Health Management
New York University 
Wagner School

The USA has the health system we want. The drug companies, insurance companies, hospitals and doctors are fond of the current system which is why they don’t want to change it. Their prices and volume are up to twice as high as they would be under a more sensible system (such as exists in most developed countries).

What makes sense is Ezekiel Emanuel’s proposal for virtual provider systems being accountable for delivering a broad scope of benefits and improving health of a population, financed by a VAT tax. Such provider systems already exist in the United States (e.g. Kaiser-Permanente). It is not reasonable (the United States is again an outlier) for employees to have health benefits determined by their employer.

What is necessary for system change is to prove that demonstrations by model provider systems “work” in the sense that they deliver high quality care that is accessible at reasonable cost.  Management research is necessary to measure how and why these provider organizations are or are not able to achieve the desired performance results.

On a vaster political level, Americans need to be involved at a grass roots level voting in non-gerrymandered districts, and children must be required to learn how their bodies function in order to graduate from high school.

All of the above is possible. Required is political leadership and citizen support.

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