Obstacles and Solutions in Healthcare Reform

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Transparency is a wonderful tool that will be part of healthcare reform, but it isn't merely transparency, making the costs available on the New York Times website or part of ABC news or any other coverage, is part of the process. What I think think the huge disruption comes from consumers themselves via either coupes or or options that are given by their employer or their insurance coverage, that actually consumers feel that part of that pain, so part of this is transparency, but the other one is people asking questions they ask in all the rest of their lives about value, and so I think that's is really healthy positive development.

As a university, we know two things. One is that the role of the physician is going to change. The physician maybe what in the business world people call much more a team leader or a team participant in the health care system. So, first of all, the role of the clinician will change, and secondly, we need to ask questions about how we deliver care and how people access their care, or it will be impossible to have millions more covered in any meaningful way.

I value the focus on wellness, on prevention and as a cancer doctor myself, I have always told people I'd love to be out of business, it'll be great not to treat cancer but to prevent cancer. One of the things to recognize though, and this is something that I think we all in medicine are now much more aware of than in the past, is extremely difficult to demonstrate cost-effective wellness and prevention programs.

So a focus on wellness and on prevention will need to be combined with some pretty tough discussions about what those cost needs to look like so that that actually is an appropriate value proposition to say we will spend money, keeping you out of the hospital, keeping you well but to do that in a way that is perhaps more self service or uses care providers that maybe lower cost, or a care setting that is lower cost.

I think if all of that is part of the dialogue then I think this focus on prevention and wellness is absolutely appropriate. Short term this is going to be challenging to move from a pay for procedure world to a world that says, here are human beings, keep them well, provide quality care and you will be paid to do that.

That's a very different system than the one we have now, but ultimately, I don't know anyone who'd argue against that transition. The argument comes around the best way to do that, the pace and how we provide healthcare for the vast numbers of people who today don't even have a healthcare provider, much less insurance.