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Getting Our Health Care System on Track

We need a new health care system where care is aimed at prevention and doctors are paid for results, not services

En español l Mention health care costs, and Mark McClellan talks about train tracks.

Few people know more about the dynamics and details of the nation's health care system than McClellan, the former director of the Food and Drug Administration and then the Centers for Medicare & Medicaid Services. One set of tracks, he says, carries the current train — with doctors, hospitals, and insurance and pharmaceutical companies organized around paying for specific tasks performed.

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The current health care system will be unsustainable if it keeps its current track of spending.

What we must do, he continues, is construct a second set of tracks for the train where health care is provided by teams delivering comprehensive care, where doctors' payments are determined by the results, where digital records are widely shared and where costs are mitigated by a vastly expanded pool of people with insurance. This is the heart of the health care reform that was approved by Congress, was affirmed by the courts and is being implemented this year.

We have a health care system that consumes 17 percent of the national economy and is unsustainable if it follows the current tracks.

Today, new tracks are being built, complete with a set of guideposts, a checklist of both critical questions and potential milestones:

Will companies cover their workers?

Employer-provided health insurance remains the linchpin of the nation's health care system, covering nearly 60 percent of those under 65. But in a sluggish economy, companies may be tempted to curtail coverage.

Will the uninsured enroll?

This is really the heart of the effort. The 21 million 25- to 30-year-olds must enroll, even though they may consider health insurance unnecessary, because their enrollment will help finance the system. Of the total 56 million now uninsured, the Congressional Budget Office projects 25 million will enroll by 2020. Those who delay enrollment face taxes that escalate as the years pass.

Is there adequate staff?

Meeting the medical needs of new enrollees will stretch the nation's already thin medical workforce. A shortage of 91,500 doctors and 1.2 million nurses is projected by 2020.

Are the state insurance marketplaces set?

And are their base insurance policies affordable?

Patients, finally, have a critical role in helping refocus our system on results rather than the number of services provided, on individualized and preventive care rather than automatically utilizing the latest gadgets and technology.

As patients, we must engage and begin pursuing smart health steps that prevent chronic disease. Attention, stakeholders! All aboard!

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