Twelve Innovative Ideas for Fixing American Health Care [Archive.org URL]

But on things like chronic care management, open access scheduling, performance measurements, standardization of practices, even behavioral health — in all of those we do have important models. If I had to say what is the one most important things out of the 12 that people have to do, I would say that it is good chronic care coordination and management. In part, because 84 cents of every dollar in health care is spent on patients with chronic illness, so it’s where the money is. It is critical to keep these people healthier — that will also save us money because we will use the system in a much better way.

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I often say that if you put conservative and liberal health policy people together in a room, we could solve the issue. But when it becomes political, we’re doing it for other reasons. We’re doing it to satisfy our base, etc. Then you have a real problem. People who think it doesn’t affect them should think again. If the insurance exchanges collapse because of uncertainty created by the Republicans and President Trump, if Medicare rates don’t keep up, if Medicaid gets cut back and more people become uninsured, that is going to affect all of us.

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There are a lot of things that can be done to try to bring the cost down, but we have paralysis. This Republican bill has literally zero on affordability, and if anything it’s going to make affordability worse. How does this match up with what the American public wants? Part of the problem is the political problem. We’ve had paralysis in Washington, so you haven’t been able to make the changes to the Affordable Care Act you need to. Everyone like me, people who worked on it, say we’ve got to make changes. No company would put in place a policy and not revise it over seven years. That is an insane system. But we have 535 people on the board of directors of the Affordable Care Act. They’re called senators and congressmen, and they don’t want to agree and actually do something. That is no way to run a system. […] No responsible person says we shouldn’t fix it. It just doesn’t make sense. Most people say we should repair it. Even conservatives say we should repair it and not throw it out.

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One of the problems we have in the United States — and this has been long recognized — is that we have too many specialists compared to primary care doctors. You should have primary care doctors doing most of the management and then bringing in the specialists as consultants for patients who are really sick or have complex problems. I think that we’ve lost that.

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Specialists get paid more, so more people go into specialties. We have to reverse that. In England, primary care doctors are the highest-paid doctors on average in their system. The specialist has prestige of the specialty, but the primary care doctor needs something else to keep them in and keep them attractive.