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    "label": "Visions of the Future from Leading Thinkers [Binder] [2]",
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    "title": "Visions of the Future from Leading Thinkers [Binder] [2]",
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        "Records of the Domestic Policy Council (Clinton Administration)",
        "Bruce Reed's General Files"
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    "ocrText": "While the digital transformation of health care gives us new possibilities, narrow laws (like the\nHealth Insurance Portability and Accountability Act) are getting in the way. HIPAA, the political\nresponse to this technological progress, may have seemed like health reform when it was passed in\n1996, but it is an obstructive, unfunded mandate at the beginning of the 21\" century. As an\nalternative, government policies and programs to accelerate the shift from paper records to\ncomputer-based information systems would do far more to enhance quality, lower costs, and\nimprove access than any health reform bill considered during the 1990s.\nLOCATION\nThe hospital has been the physical center of our medical system over the past century for a variety\nof defensible reasons, but most of them are rendered obsolete by the technological and economic\nforces reshaping health care. The enduring image of 20th century medicine is a patient\nhospitalized for surgery or an acute illness (e.g., heart attack. cancer, broken leg). With the\nrelative rise in chronic health problems (e.g., diabetes, obesity, substance abuse) and remarkable\nprogress in drug-based therapies, outpatient care is the wave of the future. The patient of the 21st\ncentury will more likely be treated at home by drugs and monitored by Internet-enabled devices\nthat can be implanted or worn on a belt.\nMany progressive hospital-based health systems understand the compelling need to shift resources\nto ambulatory care. but their ability to respond to the new possibilities is sadly diminished by the\nBalanced Budget Act of 1997 and other reforms based on an inpatient view of health care. Health\nreform is taking money away from hospitals at the very time they need capital to create an\noutpatient-oriented, information-based delivery system. Government policy could do good rather\nthan harm by rewarding investments in the technologies of the 21st century.\nPAYMENT\nMedical economics establishes clear links between many problems of 20th century health care and\nour nation's unique approach to health insurance. Yet, if reformers have their way, every\nAmerican will have a health plan with many or all of the features that created the mess we are\ntrying to escape. Adding more fuel to the fire makes no sense. The rise and fall of managed care\nin the 1990s clearly exposes the flaw in efforts to accomplish reform by trying a new variation on\na tired old theme-insurance provided, paid, and controlled by a third party (employer or\ngovernment). Progress will escape us until we give meaningful economic responsibility and\ncontrol to patients.\nFortunately, we are soon likely to experience a dramatic shift from defined-benefit plans\ncontrolled by third-parties to defined-contribution plans controlled by consumers. Today's\ninformation technologies will allow insurers to put a price on moral hazard and will give patients\nthe capability to customize health plans to meet their perceived needs and match their budgets. A\nwide variety of new insurance products will be offered, replacing the \"one size fits all\" policy that\nhas priced so many Americans out of the market. This transformation will soon start occurring\nwith remarkable speed, thanks to the technologies of e-commerce, repeal of the Glass-Stegall Act.\nand the absence of any political leaders with a viable alternative.\nNew Tools\nIn conclusion, the health care system of the 21\" century will be built with the tools of new science,\ntechnology, and economics. Further efforts to reform health care with 20th century ideas will only delay the\ninevitable reinvention of health care in the United States.\nDr. Jeff Bauer - An Insider's Forecast for the Future of Health Care - Page 3"
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