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Providers key to reform: Bredesen

Jan. 17, 2013, 9:34 AM

More than 200 students, faculty and community members gathered Monday to hear former Tennessee Gov. Phil Bredesen discuss his thoughts on meaningful health care reform, as part of the Vanderbilt University School of Nursing Centennial Lecture Series.

Former Tennessee Gov. Phil Bredesen with School of Nursing Dean Colleen Conway-Welch, Ph.D., CNM, at Monday’s event. (photo by Anne Rayner)

His message: Members of the health care community, not just elected officials, have a responsibility to help solve the health care problem.

“I really do believe medical centers like Vanderbilt ought to be leading the discussion in the country,” said Bredesen. “It’s headed by some very smart people … and I would much rather the people standing within 500 yards of me now do the fixing than a bunch of accountants or management consultants or someone else operating out of a K Street office in Washington.”

The problem, according to Bredesen, is that in the United States, “if you have health insurance, the purchase of health care is extremely inelastic. The cost of a procedure, the cost of a drug, the cost of services in that system have little to do with whether it’s consumed or not.”

Bredesen focused his comments on what he called the broad shapes of the health care issues in our county.

Under the Affordable Care Act, he expects health exchanges will transform how health care is delivered because there will be a substantial decline in employer-based insurance that will have cost and innovation implications. He also shared his concerns about how to pay for the new law.

“The biggest shape in reform is one that isn’t there,” he said. “If you believe it’s all about the economics, you need to find better ways of financing the delivery of health care, and I do not see a robust quality assurance structure.”

He said the health care industry needs a set of quality standards — measuring techniques in real time to see if standards are being addressed. He cautioned that quality assurance is not about counting visits, but about assessing the individual care.

“It’s hard to believe that quality standards set by doctors, nurses and medical field professionals would not transform the process for the better,” he said.

As far as future reforms, he would like to see a health care system that provides a base level of care as a right of citizenship. He said health care has to be delivered through a system of care that balances cost of care appropriately with objective and public quality measures.

He also said he would like to see a strong quality assurance system with public results so customers can “vote by their feet.”

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