Why have the past reforms not worked?
Discussions of health care reform traditionally focus on health insurance access and coverage. But the central goal of reform must be to improve the value of health care (the quality of health outcomes per dollar expended). Not only is improving health the purpose of the health care system, but more access and more coverage become possible with dramatic improvements in the value of health care. Past reforms have assumed that the quality of health care was good enough, and seen the problem as cost. However, one of the paradoxes of health care is the more the focus is on driving down costs, the more costs tend to go up. This is because efforts to control costs often degenerate to cost shifting and eliminating discretionary but high value preventive and monitoring services, while introducing major inefficiencies in the system. Value is eroded in the long run. The best way to reduce cost is to drive improvements in quality, measured by results. There is ample evidence that better quality c
