Monday, February 17, 2014

A modest proposal for improving chronic care

Yevgeniy Feyman, as prelude to a proposal* for controlling medical costs for those requiring chronic care (forthcoming in a sequel post), notes:

A 2012 AHRQ study found that in 2009, 1 percent of the population accounted for 21.8 percent of total health care spending.
That imbalance brings another one to mind: the highest-earning 1% of Americans took home about 22 percent of the nation's income in 2012, according to a study by economists Emmanuel Saez and Thomas Piketty.

With apologies to Feyman, I feel compelled to cut in with my own modest proposal for bending the chronic care cost curve -- one  in keeping with our nation's growing reliance on the bounty of billionaires.


Let's hook up the financial 1% in a matching program with the medical 1% -- in an adopt-a-chronic-care-patient program. Voluntary, of course -- let's call it A Million Points of Light. Each high earner will undertake the ongoing cost of care for a chronic patient, for as long as the earner remains in the top 1% and the patient's chronic condition persists. In full consultation with the patient and her medical providers and payors, the Adopter will devise a plan to coordinate care and improve results while reducing costs. Any cost savings will simply reduce our Highly Effective Earner's financial burden. We can make the plan tax deductible, and even share the benefit of any reduction in the cost of care by not reducing the deduction proportionately.

This plan, like the cost control pilot programs in the Affordable Care Act, should serve as a laboratory for various methods and theories of chronic care cost control.  A Million Points of Light not only taps the inherent generosity and creativity of the Ameritocracy -- it  also has the potential to transform our healthcare system without relying on the heavy hand of government.

Government does have a role to play, however. As the program will cost no money, it can be created by executive order. To remove any partisan taint, the president should appoint a leader from the opposing party. Someone with extensive managerial experience (remember the healthcare.gov debacle?), a proven commitment to effective healthcare reform, and known credibility with the financial one percent. Someone like Mitt Romney.

*          *          *          *

* Feyman's current post lays out the financial imperative for more effective chronic care, ending with this preview of a serious proposal:

So what are we to do? The answer lies in basic science. An important reason for the skewed distribution of health expenditures is the prevalence of chronic diseases – and treating them requires sufficiently funded research into the basic biochemistry of these illnesses. Stay tuned for part two, where I will discuss exactly why this is the case, and what it means for our federal spending priorities.

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