Elizabeth Edwards and Mandates

Mandated enrollment into the present healthcare system as a means to achieve universal healthcare, as suggested by Elizabeth Edwards in a recent interview by ABC News' Molly Hunter, will not work unless measures are put in place to control cost and to improve quality of health care. Without cost control measures, premiums, deductibles, and co-pays will continue to escalate. Without quality control we will still have suboptimal outcomes of treatment which in turn leads to increased cost.

Basic health care for everyone is essential, but reimbursement should be denied for medically unnecessary procedures and diagnostics above that which is basic. For a definition of "basic" healthcare, read my blog titled: Basic Healthcare. There are two major initiatives which, if ever launched, would reduce medically unnecessary utilization of health care benefits. One is stringent practice guidlines,created from a concensus of opinion by medical specialties, for treating the most frequently occurring illnesses . The other is denial of reimbursement for referral by physicians and other providers to entities in which they have a financial interest (imaging centers, laboratories, home health agencies, hospice services, and day surgery units, for example).

Quality Improvement is a must. The CMS has already initiated "core measures" in four areas at present--heart failure, heart attacks, pneumonia, and surgical complications--to achieve better quality of care. There will be more measures added in the future that will demand more attention to preventing medication errors, to the appropriate treatment of diabetes, and to infection control in health care facilities, to name a few. All healthcare providers will have a financial incentive to improve.It's the "Pay for Performance" concept.

Without Utilization of Benefits Control and without Quality Control, costs go up which, in itself, leads to increses premiums and deductibles. The payers (the health insurance entities) and the health professionals, with our present system, have no incentive to control costs and to improve quality of care other than integrity. And unfortunately integrity is often missing.

It is encouraging to see that a few of the political leaders in the country are taking a lead roll in taking action to repair the present healtcare system in the United States.