October 20, 2014

How to Restart Health Care Reform

Robert Graboyes

Senior Research Fellow
Summary

Midterm elections are coming, and both parties are lobbing grenades over health care. Despite the furious rhetoric, the two sides are more alike than they realize. Both spent decades pursuing policies that obstruct health care's capacity to save lives, ease suffering and cut costs. The endless vitriol resembles World War I-style trench warfare. The Affordable Care Act moved the battle lines a little in one direction; the midterms that year moved them a little in the opposite direction. With divided government, the 2014 elections will move the lines even less.

Midterm elections are coming, and both parties are lobbing grenades over health care. Despite the furious rhetoric, the two sides are more alike than they realize. Both spent decades pursuing policies that obstruct health care's capacity to save lives, ease suffering and cut costs. The endless vitriol resembles World War I-style trench warfare. The Affordable Care Act moved the battle lines a little in one direction; the midterms that year moved them a little in the opposite direction. With divided government, the 2014 elections will move the lines even less.

But those weary of the trenches can begin improving health care in January 2015 by shifting to a different theater of a different war in a different era. Think Pacific Islands, World War II. Think innovation.

For 70 years, one side asked one question only: "How many Americans have insurance cards?" The other side pushed back feebly, claiming a superior ability to distribute cards. Both sides focused on distributing care and ignored creating care. Both contributed to stagnation by obstructing innovation. To understand how, compare health care with the most innovative industry of the past 25 years - information technology.

Imagine riding a time machine to 1989 to tell your friends how health care has changed. They'll be mildly surprised by some specifics, but they'll believe you. Now tell them about IT in 2014: iPads, smartphones, Siri, Amazon, Kindle, Street View, email, iTunes, Netflix, Facebook, Twitter, GPS, Uber, Skype. Tell them how inexpensive it is. Talk about driverless cars, drones, and Bitcoin. Now they'll think you've lost your mind.

Health care lags behind IT in innovation because we've locked health care in a "Fortress" and let IT roam the "Frontier."

In the health care Fortress, policy has two goals: The first is imagining every terrible thing that could go wrong and striving to prevent any of that from happening. The second is making sure doctors and hospitals and health researchers never worry about outsiders threatening their financial security.

On the IT Frontier, policy recognizes that big improvements in quality and big decreases in cost require people to accept some calculated risks. The Frontier allowed Apple and BlackBerry to challenge IBM and Western Electric. Outsiders in garages upended insiders in corporate towers.

Bipartisan consensus allowed IT to thrive on the Frontier but confined health care to the Fortress (even as they argued ferociously about details).

But, you say, health care and IT aren't comparable. Health care involves life and death, pain and suffering. Computers are harmless.

Think again. Computers and smartphones offer terrifying ways to commit financial fraud, stalk and bully the vulnerable, steal identities, violate privacy, destroy reputations, and coordinate terrorism. Wireless telemetry failures put airline passengers and surgical patients at mortal risk. 1989 policy makers could easily have banned the internet and computers and smartphones. Thank goodness they didn't.

Now, take your time machine 25 years into the future. 2039 medicine will likely be as unfathomable to you as 2014 IT seems to your friends in 1989. The question is whether American health care spends those years on the Frontier and leads this technological revolution or, alternatively, remains in the Fortress, leaving other countries to take the lead.

I've been honored to meet some harbingers of the future. Ivan Owen - a puppet-maker who saw $40,000 prosthetic hands and co-invented one costing $10 to $50. Ian Shakil, who doubles doctors' output by freeing them from oppressive interaction with computer keyboards. Pat Basu, who delivers medical appointments by tablet and smartphone. And Jenna Tregarthen, who uses tablets and smartphones to help hundreds of thousands of people struggling with eating disorders.

Other technologies are coming: printed replacement organs, nanobots traveling deep within you to repair damaged genes, pharmaceuticals custom-designed for your DNA.

So how do we mimic the leaps and bounds of IT within health care? Currently, one side struggles to preserve the sputtering ACA. The other pledges to repeal it with a bill they haven't written, using power they don't possess. Regrettably, neither approach will do much to improve Americans' health or financial security.

There is a better path.

Instead of the futile back-and-forth of World War I, we can enter the Pacific Theater of World War II. Identify 10,000 islands blocking the way to innovation of care. Conquer lots of them simultaneously. Attack small pieces of Medicare and the FDA and the ACA rather than tackling the entire health care system in one piece. At the state level, conquer individual obstructions like certificate-of-need and occupational licensure provisions.

Regardless of this election's outcome, island-hopping can begin in January, with coalitions spanning both sides of the aisle, uniting to clear the way for innovation.