A Down-to-Earth Idea for Health Reform

As a futurist on the speaking circuit, I am generally asked to make my comments from the “30,000 foot” perspective. Meeting planners seem to assume that something as uncertain as the evolution of health care can only be viewed from a high level. Fortunately, audiences seem interested in my assessment of the probabilities of a broad array of possibilities—especially in the context of recent health reform laws. Listeners would rightly reject my forecasts if I told them exactly what was going to happen. Nobody knows. Any number of things, many unforeseeable, could occur in the medical marketplace.


I was caught off guard in a speech last week when a prominent elected official in the audience asked me what could be done right now to address serious threats to health care at the state and local level. He wanted a “down-to-earth” example of a homegrown solution, independent of federal reform. Specifically, he asked, what responsive action could be initiated locally in 2010 without waiting to see what happens in Washington between now and 2014?


The pointed inquiry gave me an opportunity to share an idea that has been on my mind for some time. (I just wish I had been smart enough to plant the question.) The solution begins with finding a provider, a payer, and an employer who are all tired of blaming each other for the ever-rising costs and uneven quality of health care. All agree that they need to change their practices that contribute to today’s mess. The parties then agree to a few key rules for the new relationship.

• First, the partners agree contractually to work together for at least five years—long enough to reap the collective benefits of investing in health promotion and disease prevention and changes in benefit design (e.g., restructured incentives).

• Second, they agree to develop a health plan for the 21st century with input from all parties, including beneficiaries. They adopt a common goal for the new approach to employee benefits, such as achieving specified improvements in the health of employees and dependents.

• Third, they make the difficult agreement that significant trade-offs will be made; more of the same won’t do. It’s time for strategic decisions that rearrange resources and relationships, seeking synergies in goal-directed change.

• Fourth, and most important from an economic perspective, the partners agree to freeze spending on health care at the current (2010) level—no increases, no decreases. The business relationships shift from arguing over unaffordable annual increases to seeking the best value for today’s spend.


In other words, the partners agree to a budget constraint—the essential step toward efficiency and effectiveness. Government’s role would be to relax rules and regulations that prevent the new partners from working accountably and transparently to do a better job with what they’ve got. It’s just an idea…what do you think?