TUCSON, Ariz. — What are the barriers to making health care more sustainable in the United States, and, really, what does that even mean?
Those questions were front and center Monday during the first day of the Siemens Health Executives Forum, playing out this week in the Sonoran Desert. With the Affordable Care Act ramping up and consumers about to start shopping the exchanges in October, politics will certainly play a key role, and the first day took a decidedly political tone.
Colin Powell — former secretary of state and a keynote speaker — skipped the nuts and bolts of reform and jumped to the more emotional side of the debate. The retired four-star general said he’s grown weary of trips to other countries where he has had to explain to foreigners why some of his countrymen get unfettered access to care while others don’t. Finding a path to sustainability in health care, he believes, means universal access. Getting anywhere near there, though, seems pretty much impossible because of the current climate in Washington.
"Right now, we are politically constipated. We’re running on continuing resolutions,” he said, later adding, "This is nonsensical. You couldn’t run a 7-Eleven store the way we’re running the United States government.”
While hospitals are mostly helpless when it comes to breaking that ongoing political stalemate, Powell said one way they can help to transform the care they deliver is by displaying a degree of empathy with every patient encounter.
"Your role is not just to provide better health care … Your purpose is what you do for the American people and the people of the world, and that’s to give them a better life,” Powell said. "A life where they know that, if they become ill or they’re injured, they’ll be taken care of, and to do it in a way that displays the kind of compassion that you would like to see given to you if you were in need.”
Powell left most of the nitty-gritty particulars of the ACA to his follow-up act, former U.S. Senate majority leaders Tom Daschle and Bill Frist, M.D. While both concurred that cost, a corresponding lack of transparency and access are some of the biggest issues plaguing the health care sector, the politicians from both sides of the aisle agreed on little else in terms of how to tackle those issues.
Frist believes that — with far fewer states wanting to expand Medicaid or set up their own exchanges — the number of uninsured that will gain coverage from the ACA has been overstated. The Republican argued that, while health care spending has slowed in recent years, little of that is attributable to health reform. He pointed to a recent Kaiser Family Foundation study that found that the average spending on health care has gone up 4.2 percent a year the past four years, compared with 8.4 percent the previous four years. Yet, about 77 percent of that change was because of the slowing economy, while 23 percent was thanks to changes in the system. Frist thinks spending will swing back upward when the economy improves and that the portion that slowed because of innovation was due to private-sector initiatives and not the ACA.
"Obamacare does nothing, nothing, nothing to change either the financing of health care delivery, or the delivery system itself,” he said. "All of the changes, and I may be doing some exaggerating, are going on in the private sector itself.”
Daschle countered, saying that health care needs innovation on both the private and public side to truly transform, and all the government experimentation will lead the way.
"The government has a little lever called Medicare and that lever has an enormous impact on the way we change direction with regard to payment policy,” he said. "The only reason we’re going to see the globalized and capitated and bundled approaches is because Medicare is leading the charge. No one knows exactly which is the right model to use at this point. You’ve got to experiment.”
Daschle thinks the ACA will spur a dramatic increase in demand for hospitals. The biggest questions are, 'Who will manage that demand and what can be done to expand scope of practice so others, such as pharmacists or nurses, can help relieve the tension. Will international medical graduates, who are only 25 percent of the workforce, play a larger role?'
Competition will only grow stronger as new patients enter the system, particularly from retail clinics. The country now has 2,500 of those types of providers, Daschle said, a 38 percent increase in one year. Mergers and acquisitions, too, will continue to ramp up — such activity jumped 21 percent in 2012, and more than 50 percent of hospitals planned to acquire a physician practice this year. Consolidation for the sake of coordination can increase quality but also may drive up costs and decrease competition.
"That tension is going to continue for some time,” Daschle said. "Do we want to see more coordination, especially with chronic illness? Absolutely. Are you going to see these new models created to be more competitive? Absolutely. The real question then becomes: 'How do you do that and still create the competitive environment within which you can really create the necessary opportunities for people to be able to participate?' That’s unknown to me.”
I’ll be blogging all week from the Siemens’ Health Executives Forum. Watch for updates on Wednesday and Thursday.