Our Proposal for Healthcare Reform

202107.15 Shewhart cycle

In May 2021, fellow blogsite Academic Masters laid out a challenge to develop a proposal for healthcare reform. Although Academic Masters typically produces its own specified essays such as this for a fee, Fixing U.S. Healthcare would like to respond to the challenge gratis!

Scenario

The United States continues to experience challenges with respect to health reform. There is considerable agreement on the need for health reform; however, there is an appreciable divide with respect to how to best achieve reform. Discussions on strategies for reform include a repeal of current legislation (the ACA), the implementation of a universal plan, and various “fixes” to the ACA.

Many would suggest that a repeal of the current system would be most appropriate, while others support efforts to “fix” the current ACA. The health organization you work for has asked you to develop a comprehensive proposal for healthcare reform.

The U.S. expends more of its Gross Domestic Product on healthcare than any other developed nation. However, the superior amount of spending has not resulted in superior outcomes when compared to other countries. In addition to higher costs, the U.S. is the only developed country that does not offer universal health to its citizens. There has been a significant amount of discourse with respect to the pros and cons of universal coverage. Those who oppose universal coverage often refer to the Canadian, single-payer system and its challenges, such as high tax liabilities for citizens, its long wait times, and the perception of the single payer system as socialized medicine. However, those in favor of universal coverage argue that the single payer system is not socialized medicine and its costs relative to the current system in the U.S. is more cost effective. Moreover, the single payer system is only one form of universal coverage. Countries that consistently rank high in terms of positive health outcomes often employ a multi-payer universal system as opposed to a single-payer system.

Instructions

You will analyze the current literature on the health system in the U.S. Your final project will include a paper, a voiceover PowerPoint presentation, and an infographic of your proposed solution. Possible solutions include a single payer universal plan, a multi-payer universal plan, a potential enhancement to the ACA such as adding a public option, Medicare for all, or a complete repeal of the current law.

The 3 Deliverables – Fixing U.S. Healthcare’s Proposal

1. A paper that includes the challenges facing the U.S. in terms of balancing the iron triangle of health – Costs, Access, and Quality. This blog post addresses the following, as specified:

  • An examination of current policy:  See “Why is U.S. healthcare so expensive?”
  • A discussion of whether healthcare should be considered a right or a privilege:  See “Neither – it’s a public good” in “Annual Review December 2020”
  • A discussion of the role of special interest groups on health reform: See “Finger Pointing at Whom to Blame”
  • Articulate the significance of the involvement the Congressional Budget Office in determining the cost effectiveness of reform:  See “Predicted Cost Overruns” in “Best Arguments against Single-Payer Healthcare”
  • Explain the importance of considering existing privacy laws in reform efforts:  Fixing U.S. Healthcare has not addressed this issue (and fails to grasp its relevance)
  • Describe and justify your potential solution to current challenges facing the U.S., including resource allocation:  See below “The Routine Part is a Process, not a Product”

2. A voiceover PowerPoint presentation that summarizes the major challenges facing the U.S. in terms of balancing the iron triangle of health, a comparison of various possible solutions, and your proposed solutions.

  • View “The Big Fix,” as a model for civic engagement, multi-faceted reform processes, and (unmet) need for ongoing cycles of improvement to continually address access, cost, quality, value, efficiency.

3. An infographic that outlines your final proposed solution to the current challenges facing the U.S. in terms of balancing the iron triangle of health.

  • See graphic of the Shewhart cycle on the masthead of this post. This is the schema for continuous improvement within each component of the healthcare system, for each process within each component, and for overarching management of the system as a whole, from each patient’s care plan up to the national goal of “appropriate costworthy care for all.”  See “Applying our Values & Philosophy to Healthcare Reform.”

Healthcare Reform:  The Hard Part

Fixing U.S. Healthcare has concluded that healthcare reform is, simply put, political reform, civic reform, and social reform. Those three reforms will naturally result in healthcare reform.  And healthcare reform – not just tinkering around the margins – can proceed only as a component and by-product of the three basic reforms.

In the previous post, “Finger Pointing at Whom to Blame,” this blog noted the need for

  • Political reform:  Re-balancing the influence of corporate spending on campaign finance and lobbying, and promoting voter voice and empowerment
  • Civic reform: Mandating public-interest responsibility for social media, and cultivating civic engagement
  • Social reform: Intentional efforts by citizens, communities and associations to connect our past (historical narratives) with future, and to “dialogue across differences.”

That’s the hard part.

Healthcare Reform:  The Routine Part Is a Process, not Product

The routine part of healthcare reform is based the following concepts:

  • Healthcare occurs within systems, including systems of systems. (Systems are collections of elements that are “tightly connected,” and no one of which can be changed without affecting other elements.  See, for example, Gerald Weinberg’s Introduction to General Systems Thinking.)
  • All components of care, financing, administration, and delivery occur in processes.
  • Processes are optimized by a cycle of continuous improvement first described by Walter Shewhart, a physicist, engineer, and statistician known as the father of statistical process control. This is called by his name, the Shewhart cycle.

This is not rocket science. Healthcare reform will be a routine, continuous, never-ending process, not a once-and-done product.

The Shewhart cycle consists of four phases:

  • Assessment:  Evaluating the current status of each process and defining measurable objectives for targeted improvement.
  • Planning: Choosing strategies that optimize the application of personnel, physical resources, and procedures toward accomplishing the objective.
  • Implementation: Doing the right thing, and doing things right.
  • Evaluation: Measuring the results.  If “in control,” re-measure and monitor periodically.  If not “in control,” re-assess, and start the cycle anew to further improve the process or to address new circumstances.

(Note:  Shewhart originally named the phases “PDSA” – plan, do, study, act. I prefer the slightly different nomenclature.)

For example, at the national level we could define measurable objectives as:

  • All persons residing in the United States and its territories are able to access essential healthcare services
  • Prices paid by federal entities for healthcare goods and services will be (gradually) lowered to “fair market value.”

Flowing from these objectives would be planning and implementation that would reverberate throughout each level of the healthcare system. And each level would then evaluate performance at a local, state, regional and national level on a continuing and recurring basis.

I did not say this will be simple, nor will it be easy.  Only, that this is “routine.” Experts in law, policy, finance, healthcare administration, and actual care delivery know how to do this. They just need the framework to do it and the removal of barriers.

Take Action

Now, think national and act local to support political and civic reforms.  Reach out to neighbors who are in different socio-political groups. You will rediscover that we’re all in this together, and might meet some interesting fellow Americans, as well.

Note from the Blog Author:  I will be taking a break from blogging for several months in order to concentrate on a local civic project.

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