First We Need To Agree on the Problem, New Jersey Doc Says

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“The bulk of federal debt is health care,” Brenner said. “It’s 18% of the economy, and we’re exploding on a sea of debt. And it’s the system itself. It’s the system and the rules we’ve made. The system is headed for crisis and the question is, how fast will it get there.”

“The problem is, we don’t have a common agreement about what’s causing the problem, so we can’t bend the cost curve if we don’t agree on the problem,” said Brenner, founder and executive director of the Camden Coalition of Healthcare Providers.

Brenner talked to California reporters this week as part of a project by ReportingonHealth, an initiative of the USC Annenberg School for Communication and Journalism.

Brenner said there are two basic choices: either ration or rationalize, as he put it. “One way is to ration care, constantly upping your co-pay, for instance, and that is often like a thousand paper cuts. Restricting a benefit is an easy thing to do,” Brenner said. “The harder thing to do is rationalize the delivery system, and make it productive.”

The trick to making care work, he said, is to keep people out of the hospital, out of the emergency department and to target the highest users of the system and keep them out of the system.

“We are doing sick care, not health care,” Brenner said. “About 30% of all health care dollars goes to 1% of population, and 90% of that cost goes to 20% of the population.”

The Camden Coalition of Healthcare Providers focused on the heavy users, Brenner said, and reducing their multiple trips to the emergency department and their frequent hospitalizations made all the difference.

“In the marketplace of service delivery, we overpay for sick care and undervalue educating patients and talking to them,” Brenner said. “The way doctors are paid now is a high-volume delivery system. It’s the same business model as the hotel

industry, they’re based on full occupancy. We are not in the business of keeping people out of the hospital.”

To keep people out of the hospital requires a community effort — blending religious organizations, homeless shelters, provider networks and many others, Brenner said.

“Health care is not going to change on its own,” he said. “So far, the dialogue about it has been, how do you pay for care, rather than what you want to buy, in terms of care. It’s as if you go to buy a car, but never talk about the car — you spend your entire time arguing about how to finance it.”

That’s what is happening in the medical world, Brenner said.

“You have to define what good care is,” he said. “What the basic attributes of good care are, and what are the cost drivers of it. Many industries now have been doing more with less, but the opposite is true with health care.”

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