#In Search of Socialized Medicine
Policymakers have always been suckers for the new new thing. Faced with the burden of rising debt and aging populations in a complex world, they reach for an arsenal of silver bullets. “Innovation,” The Economist once declared, “is the new theology that unites the left and the right of politics.”
And so it is with health care: if there is an inviolable premise to the myriad new demonstrations and pilot programs being tested in the Patient Protection and Affordable Care Act (PPACA), it is that we can innovate our way to a better system. Section 3021 establishes the Center for Medicare and Medicaid Innovation (CMMI) to allow hospitals systems and provider groups to test promising care and payment models. Section 6301 establishes Patient-Centered Outcome Research Institute to coordinate comparative-effectiveness research priorities and disseminate findings. There are initiatives for integrated care around a hospitalization (section 2704), payment bundling (section 3023), and community-based wellness programs (section 4202), each one with the potential to unpack the secrets of our monolithic health care system.
To be sure, it's a daunting task. In 1999, the Institute of Medicine’s landmark report, To Err is Human, found that preventable errors in hospital care were responsible for up to 98,000 deaths every year in the United States. More than a decade later, we are doing no better – the Agency for Healthcare Research and Quality’s National Healthcare Quality Report found that, nationwide, hospitals are improving by less than three percent per year across 179 quality indicators. Words like “fragmented,” “siloed,” and “uncoordinated” pepper conversations on the deficiencies in health care because it is understood that there is a real gap between finding the best solutions and translating them into care improvements.
But the best solutions are out there. Private and public health systems -- Geisinger, Kaiser Permanente, Mayo Clinic, and the single-payer VA system -- have received high marks from policy experts and industry insiders for their efforts to achieve greater patient outcomes while still holding down costs. And with the passage of PPACA, never before has there been such a large effort in national policy to converge around the best ideas and propel them forward. Last month, HHS launched the Partnership with Patients, an unprecedented collaborative between government and the private sector to encourage quality innovation in medicine. A few weeks later, Medicare announced a bonus payment strategy to reward hospitals for providing quality care. The efforts are guided by what President Obama described, in a June 2009 speech to the American Medical Association, as “a simple principle: fix what’s broken and build on what works.”
Policy, it appears, is nudging us towards a new era of quality care; our health care system is finally learning how to learn.
But there is a bitter paradox in the policy efforts to improve quality: they aim to confront national problems which manifest themselves in highly local and personal ways. And the more we rely on policy to lead us towards a better system, the more we deny the most valuable asset in achieving that goal: the very human we innovate in health care.