MIT's Steve Spear makes the point again. "We can provide much better care to many more people than we currently do at less cost and with less strain on providers." How? By engaging in a real effort to reduce harm to patients by redesigning the work flow and patterns in America's hospitals.
Why do so many observers insist, in contrast, that changes in the reimbursement system or other structural changes in the health care industry are the answer? Well, if you are an insurance company or public agency payor and have the "hammer" of insurance rate design, every problem looks like a "nail." You seek to influence behavior with the tool at hand.
If you are an employer and have the "hammer" of plan redesign, every problem looks like your kind of "nail"-- raising co-pays and reducing benefits.
Meanwhile, if you are a union, your solution is to lobby the government for an increase in costs. When you have the "hammer'" of thousands of members, you use your accumulated union dues to engage in a public relations campaign and the implied power of that constituency to pound the legislative "nail."
Doctors, nurses, and hospital administrators know that these methods are crude and poorly constructed to solve underlying problems. For the most part, they mainly shift risk and costs.
Yet, who can blame the others for their attempts to use the tools they have, when the health care professions have abdicated their role in solving the cost problem? The solution, as Spear notes, is literally in the hands of the very people who deliver care.