I Guess We Haven’t Tried Everything Else Yet

Every one of the five health reform proposals in Congress purports to attack the quality issue*—you know, the minor problem in this country that results in

• as much as 30% of all health care costs being attributed to waste fraud and abuse
• thousands of deaths each year from shoddy or inadequate medical care
• variations in care so extreme that some areas of the country look more like the third world and other areas provide the best care in the world.

And now the National Committee for Quality Assurance says quality is not getting better.

The 2009 State of Health Care Quality Report from the National Committee for Quality Assurance reveals that after 10 years of quality improvement, “the quality of care in America appears to have reached a plateau.” The report goes on to note that “With a few key exceptions, quality measures in the three major sectors of our system — commercial insurance, Medicare and Medicaid — were flat.”

Richard Sorian, vice president of public policy with NCQA, attributed the slowing performance of health plans to the economy and the pay-for-service model. "In many cases employers and health plans have taken their eye off quality to focus on cost-cutting," Mr. Sorian said, adding that the health industry's pay-for-service model does not create an incentive to improve the quality of care.

Improving health care quality would have significant benefits beyond the health care system itself, according to NCQA. The organization estimates that were all health plans able to perform at the level of the top 10% of plans, the U.S. would avoid up to 115,000 thousand deaths and save at least $12 billion in medical costs and lost productivity every year.

Health Reform Talk already has elaborated on these quality issues (for example, here, here, and here), and virtually every legislator, health care expert, and interest group advocates for quality improvements as a part of health care reform.

So why do many of us suspect that quality improvement in health care will remain elusive under any of the proposed reform bill? Why do thousands of deaths caused by a chaotic health care system elicit so little outrage?  Why don’t proven employer approaches to quality and cost control (like those of Pitney Bowes) spread like wildfire throughout country?

I can only hope that the well known quote attributed to Winston Churchill is accurate in regard to health care: “You can always count on Americans to do the right thing‑after they've tried everything else.”

*See, for example, all of Title III of the Senate Finance Committee's America's Healthy Future Act.