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December 2008
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Healthcare reform- it’s about information and choices, stupid!

Two interesting articles caught my attention this week and I hope you’ll take the time to read them too. What’s the Right Decision appearing in the Fall edition of Cure magazine and written by Jeffrey Belora, director of Decision Services at University of California, San Francisco Breast Care Center and then in the 12/22 BusinessWeek Health section is a story entitled, “If Health Care Were Run Like Retail…

In his article Dr. Belora discusses the theory that having all the information can make descision-making easier and the reality that we can never have all the information and that not even more information can make it easier. To paraphrase the good Doctor, “We may be able to narrow the range of uncertainty, but we will still need to weigh the risks and benefits.” He concludes by suggesting that there are some good lessons that could be applied to healthcare by adopting the shared decision-making that works in engineering, aeronautics and other high-stakes, high risk situations. While I don’t dispute his proposal, I’d like to recontextualize his risks and benefits proposition by suggesting that until the healthcare consumer-  or the caregiver watching over someone gets the information they need so they can make intelligent choices (or indeed any choices), the healthcare system will remain broken.

The BusinessWeek article presents the position of Regina Herzlinger, a Harvard B-School professor. Dr. Herzlinger has authored several books including “Who Killed Healthcare” and Consumer Driven Healthcare. Money magazine refers to her as the Godmother of consumer-driven healthcare. My kind of lady.

According to the story, she believes that healthcare insurance purchasing should be mandatory, that consumers should be able to tailor their own healthcare coverage and (most importantly to me) is that a national database would be created that contains prices and outcomes for procedures at every hospital and clinic so consumers could make informed choices. That’s the information part.

In the article, some of Dr. Herzlinger’s critics argue that healthcare is too complicated for consumers to sort out on their own and insurance too costly a burden for the individual. Dr. Robert Galvin global health director for GE says that Americans wouldn’t give up employer-provided health insurance. He’s right in a way. It is complicated. But for 47 million uninsured and 10 million unemployed Americans, that decision has already been made.

While employers have a self-interest in managing healthcare costs, they have less of an interest in (and less time for considering) quality of care. And anyways, who are we trying to kid? Employers don’t pay for health insurance. The consumers of the products and services those employers produce do. Interesting fact: healthcare costs add $1,525 to the cost of every car produced by General Motors. Compare that to Japan where their universal healthcare system results in an upcharge of just $125 per car.

How did we get to the point at which it’s easier to shop for a digital camera than for the place at which you’d like to have heart surgery?

I think we sell the American consumer short. Provide some information and some choices and people will choose. Along the way, we’ll learn that the information they have isn’t adequate enough and their choices aren’t clear and the system will begin to evolve.

This is already happening. Thousands of Americans are evaluating their options and then choosing to have elective surgery performed in hospitals and by doctors outside the United States. lists complete packages of hospitals and doctors to choose from, each including a detailed description of specialties, credentials, certifications and references. They don’t publish prices, but family members who have used their services save 40% or more. You can fill out a quick email form and they’ll quote you.  There it is… information and choices.

Think of it. Before that young couple decides to have their first child at Metro Hospital, they might look through Consumer Reports to learn that the care at Main Street General is to their liking and by using them they will save 10% off their insurance premium for the next six months because that particular hospital doesn’t offer delivery of meals to the room. You must bring them in yourself but the good news is that your regular doctor can work in any hospital they choose to. Sorry- but today, this is all promise not reality.

But now we arrive back to the subject of information and choices.  Won’t someone please explain to our healthcare cartel that it doesn’t have to be this way; that information and choices are better for all?

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