Ken Terry is the author of the new book Beyond Medicare for All: Cracking the Code of the Healthcare Affordability Crisis. His other books include Physician-Led Healthcare Reform. He is also a journalist.
Q: What inspired you to write Beyond Medicare for All?
A: About 20 years ago, when I was an editor at Medical Economics, the business magazine for doctors, I began thinking about how the healthcare industry could be restructured to provide universal access to comprehensive, affordable healthcare.
At that time, I believed that Medicare for All was possible, and I based my reform model on a regionally administered version of that approach. But after I had written two books on the subject, published in 2007 and 2020, I realized that Medicare for All was not politically feasible. So I came up with a free-market alternative that allows health insurers to stay in the game. The result was Beyond Medicare for All.
Q: How would you reform the insurance market to improve U.S. healthcare?
A: I would divide health insurance into two parts. First, I’d have competing primary care groups of a certain size charge subscription fees for all basic care—the care that most people need most of the time, including the lower levels of specialty services. Those fees would roll up into a budget for each group. So the primary care groups would be taking financial responsibility for basic care—the definition of insurance.
To do well economically, they’d have to improve population health and reduce waste. If people were healthier and had their chronic diseases under control, fewer of them would be hospitalized or referred to specialists. As a result, costs would come down.
Second, traditional insurance companies would cover everyone—including those currently on Medicare, Medicaid and private health plans—for the cost of hospital care, nursing home and rehab care after hospitalization, and the more expensive forms of outpatient care, such as ambulatory surgery and cancer care.
Employees who are now covered by company-sponsored insurance would choose one of these “major medical” plans from a menu on an online insurance exchange, similar to those of Obamacare. Benefits would be standardized and comprehensive, although some plans might offer extra benefits for a higher price.
Individuals, employers, and the government would split the cost of major medical insurance and subscriptions for basic care.
Q: What changes would you like to see when it comes to hospital budgeting?
A: I like the system that Maryland has introduced over the past several decades. To start with, the state established an all-payer rate-setting process, in which each hospital had to charge the same prices to Medicare, Medicaid and private insurers. That eliminated the market power of hospital systems, which continues to drive up the cost of care.
Second, Maryland required hospitals to negotiate global budgets with the state, based on their individual cost structures. They can raise their prices if they come in under budget but must lower them if they exceed their budget. This has also helped to lower the cost of hospital care in Maryland.
I’d like to see every state adopt this approach, which would give hospitals the same incentive to restrain costs that the basic care groups would have. In addition, if hospitals took financial risk for the cost of care, insurers would have no reason to deny coverage of medical services.
Q: What role do you see AI playing in healthcare reform?
A: AI should be used to support physicians, not replace them. By helping doctors document care, comb notes for pertinent facts, triage online communications with patients, and facilitate other routine functions, AI could make it easier for physicians to diagnose and treat patients.
In addition, AI could be used to orchestrate the many tasks involved in population health management.
Q: What are you working on now?
A: Right now, I’m trying to get the word out about my book. As part of that effort, I’m writing op-eds and doing podcasts. It takes a lot of time just to keep up with everything that’s happening in healthcare.
Q: Anything else we should know?
A: Every American deserves high-quality healthcare. We’re a long way from that now: nearly a third of our people lack a regular source of primary care, and about half of those who answered a recent poll said they couldn’t afford healthcare, although 90 percent of our population is insured.
Clearly, our system is broken, and we need a better way forward. I think that the model described in my book can help get us there.
--Interview with Deborah Kalb
No comments:
Post a Comment