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The Role of Academic Health Centers
in Health Care Reform
2006 Annual Meeting
San Antonio, Texas
Competing Visions and Common Elements
Len M. Nichols, PhD, Director, Health Policy Program, New America Foundation
Len Nichols, the John P. McGovern award recipient, shared his insights on where political parties and players stand on health reform and how and why they can find common ground. In the weeks before the Midterm elections, Mr. Nichols addressed the questions and controversies in health reform that he predicted would emerge regardless of the party in power.
Competing Visions and Common Elements of Health Reform
Political environment
- Progress on health reform is hampered by political gridlock and fear. Republicans don't want real reform discussions, because universal coverage threatens tax cuts and because serious cost-growth containment will require an enhanced government role.
- On the other side of the aisle, Democrats don't know what they want. Some see universal coverage as an advantageous political issue and want to capitalize on it, while others see it as a negative political issue and want to avoid it.
"Progress on health reform is hampered by political gridlock and fear."
Competing visions of the health care system's problems
- Right: High costs are caused by too much insurance coverage (individuals are insulated from real prices and overuse health care as a result).
- Left: High costs are caused by excessive market power (adverse selection and the drive for high profits inflate costs).
- Center: All of these problems are linked, and must be addressed simultaneously, for both technical and political reasons.
Competing visions of health reform
- Right: People are on their own — individual choice and market responses will drive efficiency.
- Left: Elite control and administrative streamlining will drive efficiency.
- Center: A credible policy must include individual and shared responsibility, encourage a culture of value, and preserve liberty and choice.
- Common elements across visions: (1) The system must become more efficient for all; (2) There will be an increase in the measurement and comparison of information, and in accountability; (3) Employers will play a less important role.
Opportunities for academic health centers to take the lead on health reform
- Demonstrate value to the local community
- Produce research to expand the evidence base for medicine
- Produce decision support tools for complex encounters
- Produce the right mix of health professionals
- Create models of "Active Medical Homes", with providers acting as navigators to coordinate care and services for the individual patient.