Hope for Health Care?
On Tuesday afternoon Mike Leavitt, the secretary of health and human services, made another of his frequent trips to New Orleans on a mission that speaks volumes about his approach to what is arguably the most important domestic policy job in the federal government.
In an interview hours before his departure, the former Utah governor told me that his purpose was to exchange ideas with local officials about how to make the hurricane-stricken city "a model of a new design for delivering health care in this country."
The urgency of the task -- not just for New Orleans but for the nation -- was underlined by a report that the journal Health Affairs issued as he left Washington. Its key finding: Health care, which now consumes 16 percent of the U.S. gross domestic product each year, will eat up 20 percent by 2015 -- a level that Leavitt said is "unsustainable without serious damage to our economy."
Steps such as the health savings accounts that President Bush has recommended, and others being discussed in Congress, can nibble at the problem, Leavitt says, but far more fundamental changes must be made if costs are to be brought under control without sacrificing quality care.
Leavitt is attacking the problem at two levels. At the top, he has assigned his department the task of developing, by the end of this year, national standards for four "breakthrough projects" applying 21st-century information technology to medical offices and hospitals. One would standardize systems for registering patients and listing their prescriptions and other basic medical data so they would not have to be entered on separate clipboards with each visit. A second would set standards for equipment allowing remote monitoring of chronic illnesses, such as the blood sugar tests required by diabetes patients.
A third would focus on systems for exchanging medical test results from office to office. And the fourth is a "biosurveillance system," designed to alert public health officials to any change in the pattern of reported illnesses that could be an early warning of a pandemic.
Once the standards are set, he said, they will be applied in the purchase of systems by Medicare, Medicaid and the departments of Defense and Veterans Affairs, creating a market that the private sector is likely to follow.
Such information systems, along with better measures of health care quality, could empower people to become much smarter consumers of health care, Leavitt says, an essential step to ensuring care at more reasonable costs without burdensome government regulation.
But worthy as these big projects may be, it is clearly the New Orleans challenge that stirs Leavitt's juices. "Hurricane Katrina wiped out the health care system of New Orleans," he said, "but it also gives us an opportunity" to build something better.
On previous visits, Leavitt enlisted local officials for such an effort. On this trip he planned to compare "the principles for such a system we have devised up here with the principles that they have developed for themselves. I have a pretty clear picture in my mind," he said, "but it has to evolve from them."
Once the principles are defined, he will await their suggestions on a structure for the new system -- and then approve what he calls "a large demonstration project" to test that design.
One feature, he suggested, will be building the system around community-based health centers, emphasizing screening for disease and prevention, rather than around the old hospital-centered system, with all the costs entailed in caring for bedridden patients.
"This is a classic example," Leavitt said, "of finding opportunity out of crisis." Then he added, "I have made quite a study of collaborative projects, and the first element in their success is common pain. In New Orleans there's plenty of pain to go around, so we are getting excellent collaboration."
Leavitt is far too experienced -- and modest -- to imagine that either the new technology initiative or the New Orleans model by itself will solve the health care crisis in this country.
He acknowledges that as long as millions of Americans lack basic health insurance, forcing the costs of their care onto taxpayers or those buying private insurance, the system will remain out of control. And he readily admits that his department's experience of trying to persuade low-income people to avail themselves of the bargain now offered in government-subsidized prescription drug coverage for the elderly shows how hard it will be to achieve that ideal of universal health insurance.
But given the size of the health care challenge, it is fortunate for the country to have an executive as creative as Leavitt heading the federal effort in this field.