The Gold Report



How to make health-care reform a platform for economic expansion

By: Peter A. Gold, Esq.
Philadelphia Business Journal
Date: Friday, July 6, 2012, 10:01am EDT

I’m not an economist but I serve on two boards of
directors with representatives of leading international
financial Institutions, central banks and even a Nobel
Prize winning economist. I am continually humbled by
their profound knowledge in their respective fields. I
surmise that they would confirm what I learned in
economics 101 - if the supply stays relatively constant
and if the demand increases at a remarkable rate it is
likely that the result will be a price increase (unless
there is some artificial actor on the supply and/or
demand curves).

Now that the Affordable Care Act has been held to be
constitutional please tell me how health care becomes
more affordable by adding 20 to 30 million more
consumers to the demand curve? This is a serious question that needs to be
addressed in the implementing amendments to the law and perhaps the
regulations. This is a call for immediate action.
On the face of it, the now constitutionally certified law increases demand by a lot
— an estimated 20 million to 30 million additional people may now be trying to
use the health-care system.
Regrettably this is happening at the same time that the number of health-care
professionals delivering primary care in the United States — the supply — is
decreasing on a per capita basis.

Further, in the last few years the president and Congress have imposed new
taxes on medical-device innovation, which could otherwise have assisted in
partially bridging this demand-service delivery gap.
While not a full cure, I believe that there is a two-prong answer to move to
bridge this demand-service gap. First, as a nation we need to increase the
number of health-care professionals providing primary care, including
preventative care providers. Second, through
sound incentives, including tax policy and deployment of private capital and
public dollars, we need to increase the rate of medical device innovation and
deployment of medical care technologies tied to delivery of care. We need to
accelerate the number and quality of cost- and labor-saving devices and
technologies going to market.

Medical and other health-care students, medical schools, all teaching institutions
(for instance, those with respected physician assistant, nurse practitioner,
pharmacy, physical and occupational therapy programs and others) should be
incentivized to do more and better. For the most part these professions and skills
are now in high demand and will be in even higher demand. They will also
provide a plethora of well-paying jobs and professional callings.
Doing this calls for some new ways of teaching and credentialing our caregivers.
Teaching, degree awarding and credentialing institutions will have to continue to
partially reinvent themselves by refining curriculum and degree requirements to
assure that they are relevant. Also, these institutions will need to utilize
simulation and modeling software and teaching methodologies to even a greater
extent. I believe that they will also have to consider even more combinations and
collaborations between disciplines and across institutional lines.
Multidisciplinary and interdisciplinary professional training and certifications will
not only continue to be important but will provide significant premiums to those
with such credentials and their employers.

These “changes” are what the business world might describe as upfront
“modernization” or “refitting” costs and investments. Teaching institutions and
health-care students need help to defray these costs — immediately! This is
particularly so because the need is coming at a time when many states — due to
their own financial and political pressures- — have cut back on public support of
higher education. Not a criticism but an observation.
Setting out the specific details of the ways to help them to defray these costs
and investments is not the subject of this writing.
However, as a general proposition, our consultancy frequently works with
universities, businesses and governments and finds, almost uniformly, that the
first step is to identify what each of the stakeholders wants. The second step is
to vision and implement an approach and/or infrastructure to deliver that value.
This generally results in desired, meaningful and sustainable results.
Further, I’m probably one of the last in a long line of experts to observe that the
United States has lost its “leader” status in some industries and in some
sciences. One of the few areas where I believe that we are still leaders and can
even advance that status is in health-care education, innovation and delivery.
Health care is a platform for current and next generation excellence and world
economic activity. Thus, I suggest that fixing this health gap should be viewed as
a challenge for sure but also as a fantastic opportunity to pursue excellence —
perhaps the next “industrial” revolution.

I know that this conclusion is not rocket science. But, speaking of rocket science,
remember President Kennedy’s challenge to the nation to put a person on the
moon. Think of all the innovations, industries, jobs, and many other advances
that were created in pursing that objective. Similarly, I believe that real
leadership here would be demonstrated by calling for a national challenge and
identifying solutions to meet the challenge of delivering high quality affordable
and even more distinguished health care. We should be global leaders and share
our accomplishments with the citizens of the world.
Furthermore, I fear that if we don’t become even better leaders in health-care
education and delivery, then others nations might overtake us and jeopardize the
leadership position we have today.

As a first step we believe that the organizational stakeholders in health-care
education and delivery systems need to immediately step up and become even
more visible and vocal leaders in calling for the funding of the Affordable are Act
provisions which focus on closing the huge gap between those who will require
health services and the number of talented professionals who will be available to
deliver that care.

We think that the time has come for a Manhattan Project- like effort. The
outcome of such an effort could be as straightforward as identifying five to 10
clearly articulated steps which need to be accomplished to close the gap and
around which stakeholders can rally and deploy talents and resources.
A catalyst to accelerate movement in this direction could be the “National Health
Care Workforce Commission.” This 15-member national expert commission,
created under Section 5101 of the Act, is contemplated to foster “…innovations
to address population needs, constant changes in technology… .” and other
factors. One of the six specific topics which the statute requires this commission
to address is “[c]urrent health care workforce supply and distribution, including
demographics, skill sets, and demands… .” 5101(d)(3). Regrettably, this
commission has not been funded in the last two Congresses.

We do not see addressing this “demand-service gap” as a political issue with its
concomitant social debate (contrasted, for instance, with the mandate to
purchase insurance).

We see this as a cost reduction and access to quality care issue. Further, tackling
this gap can be a platform for expansion of the U.S. economy, to advance health
care technologies, and for creation of high paying skill rich employment
opportunities. All, one would hope, are shared goals among rational thinkers
regardless of political persuasion.

The challenge is here and now. What steps do you propose?

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