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Newt Gingrich, whose Contract with America helped to elect the first Republican House in 40 years, is back with a more ambitious nonpartisan project: to transform the nation's health care delivery system.
The first laboratory of experiments is likely to come in the South (Georgia, Florida and South Carolina) and in the West (Idaho, Montana and Colorado), along with Maryland and West Virginia.
Gov. Sonny Perdue embraced the idea at Thursday's Georgia Public Policy Foundation conference on health care co-sponsored by Gingrich's Center for Health Transformation.
It's a big idea. The premise is that the system is fundamentally broken. Consumers buy without regard to price, have little or no financial incentive to maintain good health and usually lack the information to make good choices. Meanwhile, as the governor describes the situation:
Nine percent of Georgians have spent an entire year uninsured. For those who are insured, premiums are rising at double-digit rates. Feeling the pinch, employers shift more costs to employees, cut back on coverage or drop benefits altogether. And, doctors are leaving or discontinuing higher-risk procedures to reduce exposure to lawsuits.
The result is, says Perdue, a crisis that's real. "And the crisis, I believe, lies more in the system part than in the health care part."
While medical care in the United States is the envy of the world, "where we have a problem is in consistently connecting the right treatments with the right patients at the right time. And, of course, paying for the quality and level of care that we all want for ourselves and our families."
What are they talking about? In Gingrich's words, a "market-driven system to drive down health care costs while improving choice and outcomes."
One need is to modify lifestyles. Stopping smoking. Getting more exercise. "If every Georgian walked 30 minutes a day, it would have more health care advantage than anything you could do," says Gingrich.
Another is to give individuals financial incentive to take responsibility for their own health care.
One possible approach is to allocate a sum, say $1,500 a year, to individuals to spend as they see fit on health care and prevention. What they don't spend, they keep, or roll over for future years. Above that, insurance kicks in.
Another is to help consumers manage high-cost diseases, such as diabetes, asthma and heart disease. In one project now in 13 counties in South Georgia, involving 25,000 people covered by state health plans, Currahee Health Benefits Solutions Inc. of Duluth provides financial incentives to encourage people to manage their weight, stop smoking, manage stress and educate themselves on managing their illnesses. The result is expected to be that people are healthier at less cost to the state.
Some simple things, made possible by medical technology, also could curtail cost escalation, which is outstripping other consumer costs. Health care spending constituted 6 percent of the gross domestic product in 1965, 13 percent in 2000 and a projected 17 percent by 2010.
Some examples of technology: Bar-coding patients, dosages and medical personnel and electronic prescriptions. Errors kill one of every 1,000 people admitted to hospitals (your chance of dying in a commercial plane crash is 1-1,860,491). It's obvious: Eliminating errors saves money.
Another example is a device that could be programmed to dispense pills to the homebound and alert caregivers if they aren't taken, or a device that allows medical personnel to communicate daily with sick people at home, and to record vital signs so that action can be taken before problems occur.
Change won't come quickly --- and it has to be based on incentives, not punishment, says Gingrich. "Punishment doesn't work."
In a free society, punishers get fired, he says. "Incentives move people to change." Jim Wooten is the associate editorial page editor. His column appears Tuesdays, Fridays and Sundays. jwooten@ajc.com
Copyright 2003 The Atlanta Journal-Constitution
