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HBS Faculty on Supreme Court Health Care Ruling
Published: July 3, 2012 We asked three Harvard Business School faculty members, all experts in the health care field, to provide their views on various facets of one of this country's most important and complex problems. nutrition, diet, physical fitness, and stress reduction. We cannot continue to ignore the obesity epidemicsweeping the nation—a serious situation that is leading to ever-increasing rates of diabetes; cardiovascular disease; cancer, spine and joint disease; and metabolic syndrome. One of the most important aspects of AHCA is the creation of designated accountable care organizations (ACOs). ACOs shift reimbursement away from the prevalent fee-for-service model that measures inputs to focus onoutcomes—keeping people well. These organizations will provide their members with the tools and teams of health professionals they need to stay healthy. ACOs will include not only doctors and nurses, but health coaches, nutritionists, physical trainers, and complementary therapists, all working together as an integrated team to provide acupuncture, meditation and relaxation therapy, massage, and yoga. Thesediverse therapies are equally important for people suffering from chronic illnesses in order to prevent recurrence of their diseases. To make such a campaign work, Americans must take greater responsibility for maintaining their health. In the future they will have a health score, much like their credit score, that is based on well-established metrics that will motivate them to improve their health.Inevitably, they will also have to assume greater financial responsibility for the cost of their care, while abandoning the myth that "health care is free." This will be accomplished through incentives for those who maintain their health, enabling them to pay less, while people who cost the system more will pay a larger proportion of their expenses. Large employers as varied as Medtronic, Exxon,General Mills and Whole Foods, all of which are self-insured, have already moved forward with such systems, and their rewards are reflected in the lower cost of employee health care and higher rates of on-the-job employee productivity. Employers must lead the way in ensuring the health of their employees and their families by demanding more aggressive requirements from their health plans or theymust work directly with large health systems. At this stage in our nation's history we face a clear choice. Continue with the current disease-based system with expanded access and watch as people get sicker and the country's financial condition deteriorates. Or mount a massive healthy living campaign by focusing on prevention, wellness, and personal responsibility. In my view the choice isclear, and the time to act is long overdue. Regina Herzlinger ?Nancy R. McPherson Professor of Business Administration and author of Who Killed Health Care? Although many conservatives are gnashing their teeth about the Supreme Court's upholding the individual mandate, had it not been upheld, their worst nightmares would have occurred. Government would have required hundreds of billions in additionaltaxes to pay for the health care of the sick. Health care expenditures roughly follow Pareto's Law: Twenty percent of users spend 80 percent of the money. If the healthy 80 percent do not buy health insurance, the sick 20 percent will not be able to afford it. In 2009, the average expenses of the sick enrolled in state high-risk pools ranged from $8,000 to $24,000. Even the top 10 percent oftaxpayers, with incomes over $110,000, could barely afford these sums. Sick people are currently insured because 40 percent of them are in Medicare, and 97 percent of the rest are covered by employers or Medicaid. The healthy people in these insurance pools subsidize the costs of the sick. But many employers, weary of uncontrolled and unpredictable health care costs, will likely soon switch to a...