Katz Op-Ed: Health care system poised to perform under reform

Delaware State News
Monday, August 24, 2009

As Americans debate what our health system should look like and how it should work, Delaware is well-positioned to take advantage of the push for national health system reform to establish a statewide, integrated health system that ensures all Delawareans are able to access affordable, high-quality health care.

The outcome of the national debate on what our health system should look like and how it should work will determine, in large part, what options Delaware will have to address our state's health system issues. Our state's small size as well as our cohesive medical community will enable Delaware to successfully address our community's unique health care needs under any model.

Shortly after I was elected to the senate, I convened the Healthcare Discussion Group made up of senior leaders of our state's health care community, including members of the medical community, health insurers, and hospitals. Our group discussed the important issues of providing access to health care for all working and living in Delaware, determining basic levels of care, insurance mandates and encouraging healthy lifestyles. I continue my commitment to resolving these issues in both of my roles as a physician and as a state senator.

As Congress and President Obama continue to negotiate our nation's shared health care goals, I hope that they remember the wisdom of the late House Speaker Tip O'Neill, who said that "all politics is local" and apply it to health-care policy. That's because a one-size-fits-all approach seldom works well in health care, given the different needs of different communities. While a broad set of federal health care guidelines can be helpful, states must be provided flexibility to meet their local needs and goals - in other words, "all health care is local."

By the same token, health care should be clearly focused on the patient to achieve the best quality of care and the best patient outcomes. While bricks and mortar are an important part of providing some health services, it is important to remember that buildings do not take care of people; people take care of people. These people are the highly trained and skilled nurses, doctors, and other health-care providers.

With these core relationships as our starting point, Delaware's health care system should be built around:

• Providing access to health care for all who live and work in Delaware, and availability of an adequate basic health care plan, which includes catastrophic coverage. No one should be denied coverage because of a pre-existing medical condition.
• A patient's ability to pay should not be a barrier to obtaining medically necessary care, including access to preventive services.
• Every person should be required to have an individual or family healthcare plan.
• All individuals should have a medical home to provide comprehensive primary care, including a personal physician to lead a team responsible for the ongoing care of patients.
• Standardized and interoperable health information technology systems should be in place to ensure that complete and accurate patient information is available to health care providers.

Streamlining administrative and clinical systems to improve efficiencies, reduce costs, and eliminate barriers to care and developing better procedures to monitor and improve patient care, outcomes and delivery.

The Healthcare Discussion Group's ongoing discussions will help to create a plan that will focus Delaware's limited health care dollars directly on patient care. Our debate must continue on these issues and we must begin to ask other questions concerning how our dollars are spent, including whether Delaware is over-investing in bricks and mortar and whether consolidating health services, including physician practices and medical services, under hospitals are in the best long-term interest of efficient and quality patient care.

While professional fees tied to Medicare fee schedules have been stable, are increases in hospital pricing and costs of treating patients affecting our state's health system rising costs and how much Delawareans must pay for health insurance premiums?

Health system reform is necessary to improve the efficiencies of our delivery system, to ensure that our community is receiving the best value for the money spent on health care and to ensure that all Delawareans are able to receive the affordable, high quality health care that they deserve.

While government should do things - such as helping to establish minimum standards for health insurance coverage, assuring that vulnerable under-served populations are able to access health care and providing appropriate tax incentives to encourage individual purchase of health insurance - it needs to understand its limitations and limit its role to these areas, leaving the actual business of providing and managing patient care to the people who best know the field.

Editor's note: Sen. Michael S. Katz, M.D., MBA, represents the Fourth Senatorial District, which includes North Wilmington, Centerville, Greenville and Hockessin.