Possiamo chiedere ai nostri candidati alle prossime elezioni politiche, e ai giornalisti che li intervistano, di farci sapere che cosa si impegnano a fare per il nostro Servizio Sanitario Nazionale?
At the turn of the last century, New York City officials had a real mess on their hands: specifically, 2.5 million pounds of horse manure dropped daily in the streets and warnings that within 50 years, the city would be buried nine feet under. Other than buying taller boots, municipal officials couldn’t agree on a solution to this problem.
But never underestimate the power of the free market to solve what government cannot. The birth of the U.S. automobile industry solved the Great Manure Crisis almost instantly. In the process, it transformed our cities, our country and our way of life far beyond the imagination of those early city planners.
Fast forward more than a century, and policymakers today face a different kind of waste problem – wasted healthcare spending – and to be honest, we are also nine feet deep. Policymakers wring their hands at the numbers: health spending is rising at more than three times the rate of inflation, while quality and safety languish far behind otherindustrialized countries. Employers could afford to hire millions more workers if they could lower their health costs to what they were a decade ago.
But just as it came to the rescue of New York City in 1898, the free market is again quietly performing major “surgery” on our healthcare system, and no matter who wins the election next week, we should brace ourselves for the changes ahead. Here are the three most influential free-market trends to watch in healthcare:
- Consumer-Driven Health Plans (CDHPs): These are plans with very high deductibles, often in the thousands of dollars. Employees pay many of their medical bills out of their own pockets or out of their tax-advantaged Health Savings Accounts. A key trade group for this is the Institute for Healthcare Consumerism, and they are advising employers and other purchasers on how to help employees navigate the health system to get the best prices and quality. CDHPs are the fastest-growing form of health coverage in the U.S. In fact, just last week, benefits executives from AT&T, CVS Caremark, Target, and Caesars Entertainment Corporation participated in a Business Roundtable meeting where they briefed policymakers that they all planned to offer CDHPs or had already done so.
- Reference Pricing: Current pricing for healthcare services is literally nonsensical. It is not uncommon for the price of a particular procedure to vary six fold or more, depending on who delivers it — with no difference in quality to explain this. Safeway and other employers have begun stating a price they will pay for certain services, and letting employees pay the difference if they choose a higher cost provider. Like CDHPs, this gives consumers the power to make their own decisions on price and quality, which in turn drives a market in the right direction.
- National and Global Shopping for Health Services: The globalization of the economy is beginning to affect the healthcare system with increasing competition for patients on a national and even worldwide level. Many employers are offering employees options to travel within the U.S. or even abroad for services like heart bypass surgery, transplants and other complex procedures.
So here’s what we need to know going into the election – whether it’s President Obama or Governor Romney who wins. A policy debate inWashington on the pros and cons of these market trends won’t make them go away. Think about it this way: there are pros and cons to having a rainstorm tomorrow, but no matter what the forecast is – you should bring your umbrella and be prepared.
One “umbrella” our policymakers could open in healthcare: more transparency. Shoppers need and expect it in order to make choices in this new market-driven healthcare environment, but healthcare is traditionally a black box. Even today, there is very little good information for consumers to use, though employers are figuring out ways around it.
The bottom line: healthcare problems can’t be solved by public policy alone. The forces that are changing our healthcare (for the better or worse) are already at work, and they’re not waiting for the election.