Dr. C. Everett Koop’s Perspective

Dr. C. Everett Koop, former U.S. Surgeon General, facilitated the last round of health care reform in the United States during the 1990s. Dr. Koop recommends that whatever is done in the health care reform process, that the legislative process be designed to succeed in protecting the health care rights of children and aging Americans, if broader reform is not politically or economically feasible. The health care reform process should also be designed to fail safely, if not successful, in order to not endanger other key services that are currently addressing the health needs of all Americans. For example, Dr. Koop recommends that a simple incremental extension of Medicare should be at the center of health care reform and that current free market health care system elements are not damaged in the process of engaging new forms of legislation and regulation.

Below are five of the most important health care reform considerations advanced by Dr. Koop for this round of health care reform, considering the successes and failures of health care reform in the 1990s and previous rounds of health care reform in the United States and in other countries.

1) Public/Private Partnership

It is critically important that the health care reform process bring together the best minds from around the country and around the world to shape a U.S. health system that can be sustained over the next few decades. Government must join with the private sector and the non-profit sector to engage the best minds to accomplish what the American people are stating as their interests in the U.S. Health System. The health care reform discourse is most likely to succeed in addressing the needs of all Americans, if it provides input by all stakeholders in the American society.

2) Extend Medicare

Savings from reducing the administrative overhead in American medicine can enable an expansion of health services to the highest priority health needs. Medicare has been a great success since its inception over the past half century and is now a trusted element of the U.S. Health System. Compared to private sector health insurance, American society has greatly benefited from the low administrative overhead (8.6%) of Medicare. The administrative cost in private insurance is over 20% in some of the most popular private health plans.

3) Juvenile Medicare (or its equivalent)

A country’s investment in the health and education of its children is a good indicator of its likely future success as a nation. American’s deep and perpetual interest in the health of its children is not fully reflected in the structure and funding of the U.S. Health System today. Far too many women lack prenatal care. Parents find many barriers to getting the health care they need for their children.

We have to make the health of children our top priority in health care reform. Since Medicare is well understood and very effective relative to Medicaid, we should look at how to reduce dependence on Medicaid, while engaging Medicare coverage for juvenile medicine.

4) Health Equity

Americans with ample resources can gain access to the best medical care in the world. That said, with over 50 million Americans are without health insurance. They may also be unknowingly compromising their health status through poor diets and other lifestyle factors. Since we now have the science and technology to measure the most common health risks long in advance of the clinical manifestation of illness, we can do far more to improve health interventions before clinical disease emerges. Prevention and health promotion, especially in the form of lifestyle management, is less expensive and improves productivity. That said, poverty is highly correlated with poor health and must be addressed to improve health equity. Poverty is correlated with poor health literacy and impacts from environmental factors that are beyond the understanding and control of disenfranchised communities and their citizens.

5) Cyberhealth

A distributed, networked, health care system architected to enable proactive consumers to access health services from their home and workplace with less dependency upon expensive hospital-based and clinic-based care can greatly reduce the cost of maintaining and improving the health status of Americans. These technologies are already available and are being used today by well over 100 million Americans, but they have not been seamlessly integrated into an interoperable system serving all Americans. Some of the best health systems today are already employing interoperable health information systems that provide health information and decision support directly to Americans, while also improving patient/provider communication. The key now is to ensure that the best of cybercare evolves quickly and is effectively distributed in networks throughout the United States with common best practices guaranteed for all Americans.