Several months ago I invited groups of patients to Southern New Hampshire Medical Center to have a conversation about health care. I have long believed the best decisions in health care are made with the patient in the room, and this was a chance to listen to determine how our health system can best meet patient needs. This particular evening opened my eyes to the responsibility each of us shares when it comes to keeping the conversation about health care reform productive and solution oriented.
Patients are nervous and uncertain about where to turn for answers where to find a fact-based discussion about the relationship between a patient and his or her physician. While listening to patients share stories that evening, it occurred to me that that it is the polarizing national debate about the cost of health care and the shortcomings of the American health care system can also erode the confidence patients have in local health care providers. In some ways (I do not believe it was intentional) health policymakers have transferred the problems of the system from the industry to the patients. We can do better.
Patients who receive insurance through an employer are experiencing dramatic, non-sustainable changes in benefits and personal “out-of-pocket” cost. Patients who lack access to insurance are concerned about being treated as second-class citizens and some fear they may not have access to care if they become ill. Patients enrolled in Medicaid and Medicare programs are suddenly aware the discounted payments doctors receive for services rendered to them are a major driver in the skyrocketing cost of health insurance. Everyone seems braced for new restrictions, decreased choice and more direct cost for the care they receive.
When we indulge in conversations that demonize either political party or trivialize the issues with clever sound bites, we are disrespecting our patients and undermining essential reforms. Sustainable solutions will require health care providers, politicians, insurance companies, patients and entire communities to work together. Every conversation that discourages collaboration or gives an excuse for any party to stay away from the table is short sighted. It may feel good to identify various boogiemen, but our patients expect more from the health care community. They expect everyone to do the work that needs to get done in order to improve the overall value of American health care.
Changes must be made to strengthen our health care delivery system and reduce the ridiculous cost of care. There is no shortage of ideas on the table. For example, Accountable Care Organizations (ACOs) propose to shift the business model from fee-for-service (the provider is paid for volume) to a system that rewards patient outcomes (the provider is paid for managing the health of a defined population).
The changes required to take such a leap are significant. This or any other new model is doomed if patients do not have confidence in the people and institutions that suggest it. That confidence comes from rebuilding trust, and trust is fostered by uniting those who are in a position to bring solutions and resisting the guilty pleasure of assigning blame.