GUILLERMO WECHSLER

February 6, 2007

Universal Health Care: A New Business Paradigm?

I recently went to a discussion on Universal Health Care.

Ronald Preston, Former Secretary of Health and Human Services in Massachusetts, brought that sharp humor that evaporated the romanticism which can be dangerous when you are trying to overcome real problems. He warned people not to think that universal coverage was only a humanitarian initiative to make health accessible to people. He also said that, essentially, this initiative is trying to save an industry that is in an acute crisis with an explosive mix of rising costs, over-capacity, and decreasing quality. In summary, he said that more insurance may help to keep this expensive industry alive. That's why we need more people inside the system. On the opposite end, Ruth Liu, Associate Secretary for Health Policy in California, glamorized the human side of Schwarzenegger's proposal.

The complexity of the challenge looks overwhelming with the variety of concerns and the different actors. What nobody in the forum seems to tackle is how poring more resources into the system that has already produced the negative results we are seeing is going to produce a different system than the one we have. The predominant service design principles underlying the discussion seem to be that health care needs to be managed top-down by the insurance companies, health care providers, and HMOs, keeping the government and politicians as the arbitrators of this complex system. I asked many of the participants, including Mary Ann Thode, President of Kaiser Northern California Region, and Ronald Preston, about the Teisberg/Porter approach on redefining health care by empowering the patient to make health conditions life-cycle value-based decisions in transparent, open markets with homogeneous quality measures and by ubiquitous access to medical records. Olmstead & Porter built their proposal from radically different theoretical design principles. Unfortunately, their book and their approach wasn't known, even though, after a short conversation I discovered that some speakers of the forum were sympathetic to it.

Although interesting, this universal health care debate lacked a radical new perspective able to simplify the overwhelming complexity of a highly regulated, hierarchical and opaque system.

Labels: health care, universal health care