OK, here's what I sent to change.gov

[Guest guest]

There is a growing sense of dismay among health care improvement

experts and health care providers interested in reforming the US health care system. The current

trajectory of the US

health care system is unsustainable and reform is urgently needed, but reports

in the media strongly suggest that the Obama/Biden health agenda plans are as

likely to exacerbate as they are to help the current situation.

Without fundamental reform of payment policies and the delivery system

we expect the current proposals to lead to the accelerated crash of the US

health system.

A high performing

health system achieves better health outcomes, experience of care, and

lower per capita cost of care.

Effective primary

care is the core of a high performing health system.

The US

is not a high performing health system and has worse population heath

outcomes, worse experience of care, and higher per capita health care

costs than other developed countries.

The basic work of

primary care (WHO 1978 Conference) includes:

Point of first

contact (I can get care when and where I need it)

Relationship over

time (I have a provider who knows me)

Broad array of

services (My primary care provider takes care of the bulk of my health

care needs)

Coordination of

care (My primary provider guides me through the health care system)

Low reimbursed fee

for service results in rapid visits with early referral or lack of

engagement on the complex issue of lifestyle change (still the most

powerful intervention available), and no ability to engage in a wide array

of services or care coordination

Primary care is a

dying breed in the US

due to the combination of inadequate funding to do the basic work of

primary care and the crushing yoke of administrative work.

The primary care

providers in the US are

ready and willing to redesign their practices if they could practice in a

favorable policy and payment environment (we have been demonstrating this

in a grant funded initiative with volunteer practices from across the US

– www.Idealmedicalpractices.org)

“Insurance for

all” and “An EMR in every office” fail to address the

fundamental flaws in the US

system and are as likely to exacerbate as help.

At the VERY LEAST we

urge funding for some demonstrations of truly transformational health

payment and delivery. The models deserving funding should include

participant outside the usual and customary players to help break the

insularity of “group think” evident in current policy

proposals.