Big Health Care Issues

The Wall Street Journal is a very informative paper and often has good articles on health care.  It put out a special section featuring a debate on what it identified as six big health care issues.   (WSJ Articles)    The issues included should everyone be required to have health insurance, should healthy people take statins to prevent heart disease, should physicians use email to communicate with patients, can accountable care organizations raise quality and lower costs, should drug patents be extended and should all patients get a unique ID number for medical records.

To focus on a couple of the discussions, the unique patient ID seems a no-brainer and is necessary if we are truly going to have nationally available instant information on a patient’s full medical history and treatment.  Not only is this critical in emergencies, it facilitates coordination of care, avoidance of redundant testing and the easy transfer of a patient’s care and medical records from one provider to another, whether due to moving or the patient’s decision to change doctors.  While there certainly are privacy concerns, they aren’t in any way exacerbated by the patient having one number instead of many.

The mandate discussion is just a rehash of well-known arguments, and the whole insurance issue is really about cost–if we can make the cost reasonable, people will get insurance.  The accountable care debate is very interesting because Dr. Berwick, one of the leading proponents of the concept, basically sticks to the idealistic notion that somehow you are going to get a group of providers to agree to accept responsibility for the cost of a population and be able to manage that effectively, when there is no example in history of this happening in any widespread form.  As the other participants in the discussion point out, providers will incur very significant start-up and operating expenses and are unlikely to find themselves financially better off, so provider support for ACOs, which was never that high, will likely quickly wane.