Health Care Reform Made Simple


My name is John Ross, and I have spent my entire 40 + year career in health care. Specifically, my background and experience are developing and managing evidence planning, reimbursement applications, and health economics strategies for several Fortune 500 healthcare technology businesses. In short, my job was to help the companies I worked for understand the healthcare marketplace from three important perspectives. The first was to answer the question, “What can we expect to be paid for the medical technologies we are developing and planning to market? The second question is, “Will the results and lower costs of using these medical technologies justify the payment level we think they deserve?

Finally, what product development, marketing, and sales strategies must we employ to ensure that hospitals, physicians, payers, and patients quickly accept our future medical technologies? Obviously, with such a focus, I had to deal with Medicare (health insurance for folks over age 65 and people with disabilities), Medicaid (state-run insurance programs for the less fortunate), and commercial health insurance companies (the companies that insure and administer employer-based health insurance plans). I also spent much time assessing the needs of physicians, hospitals, and large integrated healthcare delivery networks that purchase and use various medical technologies.

Health Care

From a funding standpoint, I have seen America’s healthcare system go from almost “anything goes” to today’s increasing focus on cost and outcomes. Outcomes are another way of asking the question; “for the dollars we are spending nationally or on a particular patient’s disease or injury, are we getting a good value in return? In other words, is the price of the drug, medical device, procedure, diagnostic or surgical intervention worth the cost of better results and lower costs compared to how we would traditionally manage this patient’s condition?

This blog is a forum for talking “honestly” about:

1. Where is health care in America going?

2. Why is it going there?

3. What can we expect from tomorrow’s healthcare system compared to what we have become used to?

4. To the best of our ability, what can we do to use less of it (think preventive health strategies)?

5. How should we think about and help those unfortunate individuals, young and old, who need more of it than we do?

6. How can we help ensure those who need health care access good health care when needed?

7. What can we do to increase the chances that state-of-the-art health care will be there when we need it and at a price we can afford?

I will also provide education on how the healthcare system works from the various perspectives of the stakeholders. We must understand these perspectives, what drives them, and the conflicts. Areas to cover will be:

1. What is happening to hospitals and physicians in this changing healthcare landscape?

2. What is happening to the development of innovative future medical technologies and pharmaceuticals?

3. Where is Medicare policy for payments to physicians, hospitals, and other care settings?

4. What is the future of employer-sponsored health insurance plans?

5. Where is the change in private healthcare insurance companies?

6. What will happen to patient costs?

7. How can I avoid premature, unnecessary, or unproven healthcare interventions?

8. What role will “evidence and data” play in giving us more information to make personal or family member health care decisions?

I would like this to be the place you can visit when you hear politicians or anyone else, for that matter, promising something from health care that doesn’t make sense. We all know the feeling we get when we hear an “it’s too good to be true” story. When we hear such fantastic promises, we better check it out; this will be where you can do that. So, bring your concerns and questions, and I will do my best to help you check them out!

Have you heard this one; “under my health plan, you need not worry. Your costs will remain reasonable, you can keep your doctor, and you will have access to state-of-the-art healthcare?”. Or, “It is everyone’s right to access the very best in healthcare, young and old, rich and poor, no matter your ability to pay.” This would be nice, but it is simply not reality, and it is the time that we talk about these things and deal with them with our rose-colored glasses removed. So, no matter what your point of view on this subject is, I encourage you to visit, ask, and comment. We need a grass-roots effort aimed at understanding healthcare, and in particular, we need to talk about its funding limits and what we can do to assure that those who need it – get it, and at a level of quality and at a manageable cost such that we can afford it as a nation. If we don’t do this, it is highly likely that health care, as we know it in America, will not be available when we face our own or a family member’s serious and costly illness.

The fundamental flaw in our approach to health care is that we have no responsibility except to expect it to be there, with no delay, and at state-of-the-art levels of care. And that, for the most part, it should be paid for by someone else. Most politicians right now are not leveling with us. They don’t want to address the areas I have managed, even in the first edition of the healthcare blog. Well, I think that we are better than that! I believe we can work on the changes coming with the right information. We want to do the right thing, but to do so, we have to be informed as to how stretched the healthcare system is and what we can do to unburden this precious resource.

First, we can stretch health care dollars and resources by taking better care of ourselves. The goal is to do what “we” can do in learning about and practicing preventive disease strategies, thereby reducing the amount and cost of health care interventions we need. By behaving this way, we free up our local healthcare systems’ funding and limited physical capacity to treat those in need. All of us who invest in preventive disease strategies will find that the beneficiaries are you, your family, and your finances. Pretty tangible benefits, wouldn’t you say? Perhaps bigger than that is what this behavior and better health for yourself and the avoidance of chronic diseases such as high blood pressure, heart disease, pulmonary (breathing) conditions, diabetes, and a host of other states can do to unburden the nation’s health care system. We need to preserve it, both in terms of resources and dollars, for those who are less fortunate and have to access the system for serious health problems. How good would that feel?

Some would say that America is a scary place to be these days. The events of 9/11, the Iraq and Afghanistan wars, continued threats from terrorism, the housing and subsequent financial meltdowns, the political infighting that gets us nowhere, and yes, the health care crisis. These all create the tendency to make us want to “wring our hands” instead of “wringing the necks of politicians” who refuse to provide the leadership we need. I have concluded. I have seen enough to know that the administration we need has to come from us, the individuals who make up the electorate. Waiting around for politicians to act means we don’t understand the world of politics. Politicians only move in one direction or another when an exercised and voting electorate (that’s us) frames the issues and leads the way to a solution. It is rarely the other way around.

Bringing it back to health care and the question of what one individual can do to improve things starts with one individual and another until millions pull in the same direction. If we manage our health to the best of our ability (and I want to emphasize, truly to the best of our knowledge) and access the health care system only when we need it, paying a little more out-of-pocket for the incidental and non-life-threatening ills and spills we all experience, the system could accommodate us all when we need it.

So there it is in a nutshell – I have spelled out what I believe is our responsibility that if we all pulled in the same direction as described above (think of disease prevention and what this can do for you and those who do need to access the health care system), we would dramatically and permanently free up this precious and finite resource. It would be there for others in need when we need it and at far less cost in most cases. We are all in this together, rich and poor, the older among us and the younger, and if we act responsibly and for the good of others in this matter, we will solve the problem. And then, we could work on the next challenge and the next one after that until we see the power of teamwork – “all for one and one for all.” That kind of thinking and behavior can work wonders. We all know it deep down – so let’s do it!

Health Care Reform

Look for a weekly newsletter and articles about health care in America. Look for weekly newsletters that discuss changes coming to employer-sponsored health care benefits, changes to Medicare and Medicaid plans, new technologies that should be of interest, and articles and commentary regarding state and national health care policies they develop in the months and years to come. Any question you have about health care can help point you to resources that will answer these questions. The specifics about your employer-sponsored insurance plan, Medicare, Medicaid, and how you can incorporate disease prevention strategies into your life with their big benefits. Ask away, and if I don’t know or can’t find the answer, maybe one of these blog participants will learn. We are all in this together, and as long as we believe that and look out for each other – everything will be alright!

Carol P. Middleton
Student. Alcohol ninja. Entrepreneur. Professional travel enthusiast. Zombie fan. Practiced in the art of donating rocking horses for the underprivileged. Crossed the country researching hula hoops in Deltona, FL. Won several awards for supervising the production of etch-a-sketches in Nigeria. Uniquely-equipped for investing in bathtub gin in the financial sector. Spent a year building g.i. joes worldwide. Earned praise for deploying childrens books in Africa.