Medical reform, Act II — how best to deliver health care
As a country, we're spending too much money overall on health care, and too little in the right places, writes Dr. David Fleming, director and health officer for Public Health — Seattle & King County.
Special to The Times
LAST week, I was back East at a meeting of the American Public Health Association when the Supreme Court announced its decision on the Affordable Care Act. Meeting attendees, huddled around iPads and reading the live blog reports, erupted into spontaneous cheers as the verdict became clear (after all, this was the American Public Health Association).
It's evident by watching TV news that not everybody was pleased by the court's decision, and we continue to hear competing, polarizing opinions on the "two sides of the debate."
With this focus on the politics of health-care reform, we risk losing sight of the real facts underlying our nation's health-care problem. The United States spends more than twice as much as any other country in the world on health care. And, despite our huge investment, our national health status is near the bottom of the pack of the developed world.
Simply put, we're spending too much money overall, and too little in the right places. Opinions on the Affordable Care Act don't change these facts. And these facts put our country and all of us squarely on the wrong side of how best to deliver health care.
If we continue to argue rather than act, we will stay on that wrong side to the detriment of both our individual health and our nation's global-economic competitiveness. We should feel great urgency to move forward with our now firmly constitutional health care, while recognizing it is only one piece of a much larger solution still in the making. This solution, which we must shape locally, needs to accomplish three goals.
First is to increase access to health care — to expand coverage to nearly 200,000 King County residents through the individual mandate and Medicaid-expansion provisions of the act. But, while access will help to drive down costs and improve health through early and more routine care, it is only a small part of the solution.
Second is to implement payment reform to curtail spending. In short, we need a health-care system that is financially rewarded for health, not sickness. This solution extends beyond health-care delivery and will require employer innovations like those being implemented by County Executive Dow Constantine, such as King County's Healthy Incentives wellness program, which saved taxpayers $61 million over the past two years, and partnerships like the Puget Sound Health Alliance, which is creating efficiencies across health systems throughout the Puget Sound region.
And third is to increase our investment in community programs that create health. The extent to which health can be influenced within the walls of a medical clinic is profoundly limited.
The average Washingtonian spends about an hour a year in the doctor's office, and the rest of the time going about everyday life. The actual leading causes of death and illness are factors like physical inactivity, unhealthy eating, tobacco use and motor-vehicle injuries. Pills and medical procedures can't treat these, but community investment — in walking paths, healthy corner stores, healthy homes and clean indoor air — can.
For this last goal, we must recognize that our health statistics are averages, heavily influenced by abysmal health in our poorest communities. Any pathway to improved health and the consequent economic prosperity resulting from it will require investment in these same communities.
Here again, we have a leg up in King County, through programs like Global to Local, which uses global-health strategies to improve health in SeaTac and Tukwila, and a host of other community partnerships creating policies and programs to reduce tobacco use and obesity in South King County. But much work remains.
Returning home to Seattle, I couldn't bear any more political grandstanding and watched the Olympic Trials instead. I think we can learn from those athletes — who intuitively understand that while winning the first qualifying heat is necessary, many more races lie ahead before the most important finish line can be crossed.Dr. David Fleming is director and health officer for Public Health — Seattle & King County.