Months ago I listed the fifteen areas I thought would need to be addressed to reform the wounded health care system. Last week I promised to prioritize. So here’s the heartheaded approach to starting down the yellow brick road to healthier health care delivery. These need to be implemented concomitantly: 

  1. Tort reform! Without it we’re banging out heads against an endless testing and retesting wall.
  2. Increase competition by allowing patients to obtain coverage from out-of-state insurers, possibly in conjunction with nonprofit health cooperatives owned by the patients. Mandatory minimum coverage for those that can afford it has to be part of this.
  3. Establish a centralized medical records database.
  4. Immediately halt the arbitrary reimbursement cuts (actually, they seem to be based solely on volume and cost, rather than utility and appropriateness).
  5. Notify physicians and providers that are utilization outliers (and by that I mean beyond two standard deviations from the mean) of their status, without penalties. 

The last will surely be regarded by many of my colleagues as stupid or naïve at best, and sacrilegious and felonious at worst. But I’ll stick my neck out since I think it may be a lynchpin to the success of any reform, the key to moderating some of the inherent excesses of the system without being punitive. I’ll discuss this further in my next post.


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3 Responses to “WHAT TO DO FIRST?”

  1. Mark Baird Says:

    Tort reform is a very broad term. I would not be for caps as that will only restrict access to the court system even when people have been truly injured by negligence.

    I believe the following article has a great idea.

    Greater Justice, Lower Cost: How a “Loser Pays” Rule Would Improve the American Legal System


    There is much myth out their regarding tort some of it fueled by the media and some of fueled by big business.

    I know of two people that should have sued their doctor for negligence but did not, so it is hard for me to understand a need for tort reform because of m experiences.

    But, I am willing to concede that both sides on this argument have valid points and experiences. As with anything in life the truth always can be found in the middle.


    • heartheaded Says:

      Sorry for the delay; this got directed to spam. Interestng article and I’ve favored a loser pays approach for some time; I like the idea of litigation insurance. I’m not sure I discard the concept of a cap “pain and suffering” though, given the tendency of juries to be as liberal with others’ money as the federal government. It’s important to remember that fear of litigation is an important, but not the only factor leading to physician overutilization. I’m posting today a possible mechanism that, along with intelligent tort reform, might impact physicain ordering patterns.

  2. heartheaded Says:

    Just read the story on robertsfight.com. As a parent, I can understand on a visceral level that losing a child is tragic beyond words. I frequently tell friends my most fervent prayer is that I don’t outlive my children. I don’t think medical device manufacturers deserve protection for negligence any more than drug manufacturers. The more complex question is when is negligence manifested? If a device is appropriately tested and vetted according to prescribed guidelines and a model fails unexpectedly after approval by regulators and release to the public, should they be held liable? Clearly, if the problem is discovered and covered up, they should be subject to both civil and even criminal penalties. However, if despite transparency and appropriate measures to correct the problem companies are still subject to litigation, this will cripple development and innovation.

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