Question of the Day

ABC News asked a panel of experts five questions about what it would take to fix the health care system, and we'll post one question and answer every day this week.

The experts include physicians, business school professors and consumer advocates.

Below is the first batch of answers they brought back -- some surprising, some simple.

Question: What's the right health care system for the United States, and how do we create it?

Dr. Alan Garber

Director, Center for Health Policy, Stanford University

One that offers high-value care to everyone, preserves choice and promotes ongoing improvement in health care.

The essential first step to making insurance available to all Americans is to find ways to deliver effective care less expensively. It will not be possible to solve the challenge by simply pumping more money into the system. Eliminating waste and avoiding ineffective care is necessary but will not be enough.

We have to recognize that some care is too costly, and that it should not be considered a necessity, even if there's a chance that it will slow the course of an illness.

Dr. David Gratzer

Senior Fellow at the Manhattan Institute, and a licensed physician in the United States and Canada. Gratzer wrote "The Cure: How Capitalism Can Save American Health Care" (Encounter Books, 2006)

I think everyone -- left, right and center -- would agree: We want high-quality health care that's affordable. Some suggest that we can only get there by expanding government. I disagree.

Americans ultimately face three options: managed care, socialized medicine or market reforms. Managed care is too paternalistic for Americans; socialized medicine is built on the rationing of care. Thus, I favor market reforms.

Regina Herzlinger

Senior Fellow at the Manhattan Institute and the Nancy R. McPherson professor of business administration at the Harvard Business School

A good health care system is one in which consumers decide what they want -- not the employer, not the HMO, not Congress.

Give everyone who has insurance from the employer the funds now used to buy health insurance. Give the poor the money Medicaid now uses to buy health insurance for them. Take away subsidies from hospitals that pay them to provide care for the uninsured and give that money directly to the poor uninsured. In Massachusetts, this amounts to $1 billion annually. Require that everyone buy health insurance with this money.

Dr. Joanne Lynn

Physician and former RAND researcher, now with the US Department of Health and Human Services' Centers for Medicare and Medicaid Services

The right health care system for America is one that gives every American the opportunity to live as comfortably, meaningfully and as long as possible in a health care system the community can sustain. That means that every person should get the treatments that have proved effective in preventing serious illnesses. Those who can be cured should be cured, and those who are chronic should live well and die comfortably when that time comes.

It also means that we can be proud of having an efficient and reliable set of care arrangements, tailored to our different priorities at different times of our lives. The Centers for Medicaid and Medicare Services has taken on a leadership role in this work for the past few years.

We will need to make successes and shortcomings visible and to work out strategies that allow communities, citizens and clinicians the flexibility and authority to build systems that achieve our aims. This will require a commitment to innovation, honest assessment, the will to endorse change, and the commitment to goals of optimal and efficient care. We will have to learn how to reduce harmful overutilization, inequitable access to care, and threats to patient safety. Doing this will require that we learn how to try out new approaches, monitor them and make corrections. CMS and the Veterans Administration have led substantive endeavors, working with clinical providers and educators.

Lisa McGiffert

Senior policy analyst at Consumers Union, publisher of Consumer Reports

We need a uniquely American solution that covers everyone, assures high-quality care and fair financing, contains costs, is accountable, and lets consumers make the choices. We need coverage that you don't lose if you change jobs, is easy to understand and use, with no "gotcha" clauses, doughnut holes, or complicated mazes and paperwork for signing up or getting services paid for. Our current flawed system segments everyone into boxes based on his or her income, age, employment and health status. When we move from one "box" to another, our access to health care changes. America needs a system that eradicates this kind of segmentation.

Americans have always found ways out of seemingly intractable problems, and health care will be no different. First, we need to get over our fear of change and admit that our current system needs to be radically restructured. More employers are shifting health care costs on to their employees or canceling coverage altogether.

People are offended by the way pharmaceutical companies insert themselves between patients and doctors through massive, often misleading, advertising campaigns, and the way insurance companies micromanage doctors' decisions.

It is critical that we create a uniquely American system that preserves and builds on the good aspects of what we have and discards the things that don't work. We know from experience that what doesn't work is a confounding assortment of disconnected programs and insurance coverage that causes individuals and families to scramble desperately every time they change jobs, are diagnosed with a chronic illness or become a year older.

Robert E. Moffit

Director, Center for Health Policy Studies, The Heritage Foundation

The right health-care system for America is one in which patients control the financing of health care. Every American would have the right and responsibility to pick and choose the kinds of health plans, benefit packages, and medical procedures that they want, at the prices they wish to pay. Every American would own and control their own health plan, and take it from job to job, and health-insurance contracts would be long term, following the life cycle of patients from youth to old age.

First, we need to replace the existing tax breaks for health insurance with a national tax credit system. The individual health-care tax credit would be refundable and available to every American for the purchase of health insurance and to offset out of pocket expenses, regardless of where they work. Second, we create a national market for insurance, allowing individuals and families to purchase affordable health-care policies across state lines from any insurers licensed in any of the states where they wish to purchase such coverage. Third, turn all government subsidies to hospitals and other institutions for uncompensated care into a pool to fund vouchers for low-income, uninsured persons to help them buy affordable coverage. Finally, we insist that every American take personal responsibility for their health care, either by buying at least a catastrophic insurance policy or by self insuring and posting a bond to guarantee payment for hospital costs if they should end up in the emergency room.

Debra Ness

President, National Partnership for Women and Families

A system that delivers the right care, at the right time, for the right reasons and at the right cost to everyone, regardless of income, gender, race or ethnic background. We have the resources to ensure that all Americans have access to quality health care, but they don't today because we have not made access to quality care a priority or used our resources effectively.

According to the Institute of Medicine, right now one-third of all health care spending results from poor quality, unnecessary care and medical errors. Billions of dollars are wasted while millions of people are uninsured, and preventable medical errors claim more lives than breast cancer, AIDS and motor vehicle accidents. We need the political will to make major changes in the ways we deliver and pay for care.

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