Patient-Centric Health Care Reform - The Buck Starts Here

The problem with health care reform so far is that it's revolving around the wrong players. What do pre-existing conditions, dependent age limits and lifetime maximums have in common? They all target the payor (insurance company, HMO, etc...)

Some advocates claim we need to make the hospitals and doctors accept greater accountability for health care quality. I'm all for transparency, but let's face it, even if we force every physician and clinic and therapist to unbutton their unmentionables and reveal the truth of patient care outcomes and treatment protocols (data on results), we're still focusing on the wrong system at the wrong point in the process. After the fact analysis of how a nurse, a doctor, or a surgical suite functioned is an ineffective exercise in finger pointing and CYA, more likely to produce added training in bedside manner than actual innovations in patient care.

What we - the patient (that's anyone who will ever get deathly ill, which is, um... everyone) need is to turn the spotlight on care while it's happening. Sadly that's not what's going on, regardless of all that healthy lifestyle advice swishing about the media of late. The real problem is that They (health care providers, policy wonks, medical system payors, etc...) want us (the customer-slash-patient-to-be), to get so focused on the prevention piece (what we can change), that we overlook our complete lack of control over the process once that fails. Which it will. Fail I mean.

I don't mean to get all Cassandra on you, but it's true. Prevention will eventually fail ... unless you are immortal. If you are, then you my friend are the exception to the rule because the human body is designed to grow old, break down, and eventually serve as compost for the next generation of organisms on the planet. Nowhere in the system currently being haphazardly deconstructed by policy-makers, politicians, and business people of all stripes, is the actual customer (the patient and his or her loved ones) being systematically empowered to make intelligent decisions once we discover, strangely enough, that our bodies are destined to malfunction in inconvenient, painful, and potentially terminal ways.

Health care delivery in the US is simply not customer-centric for all the proud proclamations various providers make about their success rates and what they're learning about treating sundry ailments. If it were, they would be making sure we had access to every bit of information about our bodies, our own care, and about the treatment of whatever is wrong with us. They would have done this eons ago (digitally speaking).

The health care system in America has been payor-centric for so long that most people don't even question why we have to ask to see our medical records, why we have to pay to have those records made available to another provider's office. And health care delivery has been provider-centric for so long that until the last decade we just took it for granted that every bit of information about what's wrong with us is written in language so inaccessible we wouldn't understand it even if we did have access to it. The idea that we own every bit of information about our health is just alien.

And the fact that the whole system is payor-centric is really unproductive because it means that while the doctor or nurse or anesthetist should be 100% focused on the patient's needs, some part of their attention is distracted elsewhere - to the government's rules about Medicare payment schedules, to the hospital review board, their end of year bonus check, the insurance company's rules around standards of care, and reasonable and customary fee schedules for the best treatment versus the most costly: which would be laughable (since they're only moderately invested in the outcome), if it weren't so frightening. The patient (again, you and me), while also invested financially, has function, quality of life, and survival itself at stake. The patient, the customer, the party with the most at stake is systematically positioned outside of the most critical decision-making processes.

So once again I have to ask, if we-the-customer have the most to lose, why isn't the focus of national health care reform on helping the customer get what he wants? Ultimately the debate should be about innovations in obtaining the best possible version of the actual product (health care) instead of the perceived product, health coverage?