By Francis M. Miller
We arrive at this point in history with health care the largest segment of our economy. It is racing toward 20 percent of GDP.
The Affordable Care Act was enacted as a capstone attempt with the hope of eliminating the uninsured and bending the cost curve. Whether it will do such is debatable. Irrespective, the implementation of the law will progress, primarily because nullification would leave us with nothing.
Opponents who decry the law offer only thin gruel as an alternative.They are largely intellectually bankrupt on the matter.
It’s time to take the Etch-a-Sketch and shake it.Toward that end, I offer the following recommendations:
1. The exchanges have a serious problem with the funding formula. They should have a small, highly competent staff to advise the market and provide policy recommendations. They are not sufficiently staffed, nor do they have the competence, to run call centers and develop large scale technology.
2. The websites have already proven their ability to generate phone calls and leads. A cooperative should be formed to staff and run the call centers under contract. The calls would come in, be triaged and handled. The insurance companies would pay a transaction fee to cover costs. Surpluses would be refunded in dividends based on patronage and their book of business.
3. As for technology, we can see the future and it is apps and mobile smart phones. It is personal and Internet-based. But health care software in a HIPPA era also demands security, testing and technical competence. Again, this effort begs for a cooperative effort.
The software systems were developed with public monies and should be pooled in an open-source effort. The contractors should not be allowed to corral the software and exploit it. A consortium should oversee the software assets and make them available to anyone willing to play by the rules of the creative commons.
4. All recent efforts have been aimed at innovation in the marketing of insurance through new channels in a new marketplace. But this is at the margins because it does not have the hope of innovating the basic product. A Manhattan Project needs to be launched to innovate the inherent laying off of risk. We should pioneer health futures contracts traded on an open, electronic exchange. To do so will take a brain trust, and research and development.
Above all, we must remove the center of power for health care reform from Washington, D.C. Many of our problems stem from the ill-advised rules created by the Center for Medicare and Medicaid in the Department of Health and Human Services. The entire effort has been hamstrung by administrative attorneys and pedestrian bureaucrats.
We should no longer seek the permission of the federal government to bring this effort back down to the level of the individual states.Colorado should plant a stake in the ground and our political leadership should move with all deliberate speed to make Colorado the epicenter for such an effort.
Success will not be a matter of funding or traditional management. For sure, those ingredients are absolutely necessary in the affairs of any organization. But, much of the money to develop the software has already been spent. Thousands of rules have been written. Now it is a matter of technology transfer. It is a matter of leadership.
We should not place the responsibility for boots-on-the-ground efforts in the hands of legislative bodies, universities, government procurement officers or social engineers running nonprofits and foundations.
A consortium of cooperative organizations operating at a meta level needs to be created to coordinate and get everyone on the Northbound Train.Think of a DRCOG for health care.
Leadership will not come from either coast. Colorado is an ideal place to launch this effort.
What we need is civic brinksmanship of the highest order.
Francis M. Miller is the past president of the Colorado Business Coalition for Health and the vice chairman of the Colorado Health Data Commission. He founded the first consumer cooperative for health care called the Alliance and is the current president of Health Smart Co-op.