Speaker Paul Ryan is in a jam.
The Republican Party has driven its “repeal and replace” legislation into a box canyon. It isn’t selling on the Hill or with the American people. But there is a way out.
As with many seemingly intractable problems, he needs to step back, rethink and come at the economic chaos in health care in a whole new light. I have talked with many of the great innovators in the delivery of health care over the last decade, and they have come up with a far better business model.
Based on those insights, I am offering this speech to Speaker Ryan – free of charge.
My fellow Americans:
The debate over U.S. health care has carried us way off track. For that I apologize.
We have spent far too much time on insurance reform and not enough time on real reform of the delivery and cost of care. We have not made the sale with you, the American people.
I look to my own state of Wisconsin for innovations. The breakthroughs I am about to roll out have been tested and proven to work in my state and elsewhere. We may have to take a time-out on the current impasse, take the necessary time and reset along the lines of these big ideas:
• Provide primary care for every family or individual. Rates must be kept low and affordable. Some call it a medical home. Many company plans already offer this huge benefit. They do it because it’s the right thing to do, and because it saves big money by helping them avoid the hospital.
Companies like QuadGraphics, which created its first medical home here in 1990, save 20%-30% of total costs. That is a huge number.
Every health plan, whether funded by a company, by the government or through an insurance policy, should provide proactive primary care.
• Are you frustrated with medical bills you can’t figure out? I am calling for a single price for most procedures. Car repair shops give you an estimate, and they must call back if the price is going beyond what they quoted. Clinics and hospitals must do the same. I know they can do it, because companies in my back yard are contracting for “bundled prices.” They are saving as much as 50% on elective episodes of care. Medicare also asks for all-in prices.
• Do you cringe when you enter a hospital, fearful of either an infection, a medical accident or an astronomical bill? I know my family does. There is a fix. It’s called lean health care, the same kind of disciplines that car companies have applied to sharply improve the quality of their vehicles.
Several Wisconsin hospitals have led the charge to lean practices, and they have driven out waste, sharply lowered costs and have eliminated defects, such as infections, which can prove lethal.
If you need to be in a hospital, pick a lean hospital. I will demand that the medical industry adopt lean practices forthwith.
• Regarding the current debate on access and insurance reform: First, let me say again that premiums will come down if people stay healthy through proactive primary care; if bundled, transparent prices are required; and if hospitals and clinics go lean. It’s the underlying costs, stupid!
Second, we will create insurance pools for people with catastrophic issues. A tax on each insurance policy, whether the insured is on an employer plan or individual policy, will fund the high-risk pools.
Third, we will ask employers to continue to offer coverage. By and large, they have done a great job with their plans.
• Lastly, we will scrap Medicaid for people who can’t afford care in favor of a model based on Medicare Advantage, a far better managed program. This will also drive down costs for the nation, since Medicare managers are already using some of innovations I have called for.
I am confident that we can sell this far better model to the American people and therefore to the Congress. Because the model I have described is far more affordable, we can afford to extend coverage in one form or another to all Americans.
Health care will always be a big budget item for the country and for every home. But the value delivered in this new model will be far higher. The dollars spent will be an investment in the health of our people and our nation.
Let’s change not only the content of the national debate, but also the tenor. Both parties should see a lot to like in these proven best practices. Let’s hammer out a bipartisan plan that works for all. Only a bipartisan piece of legislation will stand the test of time.