In the News
In the Know
M ention health care costs, and Mark Mc-
This Train Is Leaving the Station
Clellan talks about train tracks. Few people know more
about the dynamics and details of the nation’s health
care system than McClellan, the former director of the
Food and Drug Administration and then the Centers
for Medicare & Medicaid Services. One set of tracks, he
says, carries the current train—with
doctors, hospitals, and insurance
and pharmaceutical companies organized around paying for specific
tasks performed. What we must
do, he continues, is construct a second set of tracks for the train where
health care is provided by teams delivering comprehensive care, where
ON THE COVER: FROM TOP LEFT: MICHAEL SLOAN/ THEISPOT.COM; DANIEL HENNESSY THIS PAGE: DANIEL BEJAR/ THEISPOT.COM
doctors’ payments are determined
by the results, where digital records
are widely shared and where costs are mitigated by
a vastly expanded pool of people with insurance.
This is the heart of the health care reform that
was approved by Congress, was afrmed by the courts and is being
implemented this year.
We have a health care system that consumes 17 percent of the national economy and is unsustainable if it follows the current tracks.
Today, new tracks are being built, complete with a set of guideposts, a checklist of both critical questions and potential milestones:
Will companies cover their workers? Employer-provided health
insurance remains the linchpin of the nation’s health care system,
covering nearly 60 percent of those under 65. But in a sluggish
economy, companies may be tempted
to curtail coverage.
Will the uninsured enroll? This is
really the heart of the effort. The 21
million 25- to 30-year-olds must enroll,
even though they may consider health
insurance unnecessary, because their
enrollment will help finance the system. Of the total 56 million now uninsured, the Congressional Budget Ofce
projects 25 million will enroll by 2020.
Those who delay enrollment face taxes
that escalate as the years pass.
Is there adequate staff? Meeting
the medical needs of new enrollees
will stretch the nation’s already thin
medical workforce. A shortage of
91,500 doctors and 1.2 million nurses
is projected by 2020.
Are the state insurance marketplaces set?
And are their base insurance policies afordable?
Patients, finally, have a critical role in helping
refocus our system on results rather than the
number of services provided, on individualized
and preventive care rather than automatically
utilizing the latest gadgets and technology.
As patients, we must engage and begin pursuing smart health steps that prevent chronic
disease. Attention, stakeholders! All aboard!
—Jim Toedtman, Editor
We need a
is aimed at
are paid for
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