Follow Here To Purchase The New Health Age (the future of health care in America)

Authors: David Houle and Jonathan Fleece

Publisher: New Health Age Publishing

ISBN: 978-0-9846390-2-1

THE NEW HEALTH AGE presents a positive outlook on the changes in our health care system that are terrifying both patients and practitioners. The authors discern game-changing developments that they say bode well for our future. David Houle, a popular futurist, and Jonathan Fleece, a leading health care attorney, introduce nine “directional flows” indicating what we can expect 20 years from now.

First they remind us that medicine and health care were not national issues until American elitists demanded “the best” of everything, including doctors, and certification came into the picture (1847). Contract medicine was conceived after the Civil War, expanding to companies post-1900. Government-provided health coverage for all has been debated only since the 1930s, long after it was adopted in Germany and Great Britain. The compelling argument for our government to be involved was summed up in Teddy Roosevelt’s remark: “No country can be strong if its people are weak and poor.”

The authors’ bête noir is absent or reverse incentives. We’ve been experiencing a spiral downward with the current pay-for-service model: There are no financial rewards for providers to keep us healthy; there are hefty out-of-pocket costs for preventative care. We need a new vision and they have one.

These authors clearly sense it’s an uphill battle, as they ask readers to put aside prejudices and keep open minds. They lean very hard on their ability to “inspire” us and count heavily on our engagement in reform. Our first step is to accept that change is continuous and fast-paced. We must embrace “The Shift Age,” to realize we are in “The New Health Age.” (I am usually skeptical of motivational seminars, which this nomenclature calls to mind, nonetheless I continued reading, already mesmerized.)

The nine forces Houle and Fleece believe will turn our sorry condition around are divided into three categories: “How we THINK about health care,” “How we DELIVER health care;” and “The ECONOMICS of health care.” Some of the concepts are familiar: wellness, as opposed to sickness, and holistic healthcare versus episodic treatment. They go on to conceptualize medicine reorganized so that everyone wins. Doctors will continue to be the leaders, in charge of “medical homes.” These are not buildings but collaborative care networks. Our access to care will expand due to both simple changes, like extended hours, and more sophisticated ones, e.g., communication technologies.

Now comes the hard part: health insurance. The authors say coverage will be affordable through stratification of employees by health risk factors. Once a worker’s risks are known, appropriate preventative actions will be taken. I say: First, we have seen negative reactions to revealing medical histories to employers, especially prospective ones. Then, even if the Health Information Privacy Protection Act were set aside, it would require tightly-budget organizations to spend up front to reinvent their employee health benefits. (The authors do not discuss homeless and alien populations because they are “outside the scope of this book.”)

Chapter 13, “Transitions Are Difficult,” warns us of resistance, but still asserts that by 2020 we will have “integrated delivery systems” (IDS), “accountable care organizations” (ACOs), “employer accountable care organizations” (EACOs), the “medicals homes” mentioned above, and “health insurance exchanges.” Kaiser Permanente and Mayo Clinic are examples of integrated delivery systems. Okay. Good. “Accountable care systems” are already being tested. Hmmm. In my mind, these sound somewhat like “accountable schools.” If a school fails it gets to start all over again under new leadership in the following year -- but the students haven’t improved.

The authors lose me here because they so limply defend ACOs and trust EACOs will be championed by employers like Virgin Healthmiles, whose web site advocates incentive programs that pay workers to “get active and healthy.” It allows a CFO to calculate how much money her company could save, but the math is invisible. To be fair, there are employee testimonials, too.

On to “medical homes” that depend on “wellness physicians” who profit by patient volume: A doctor talks to 100 patients about heart disease prevention; attendees pay $20 for a ticket; doc gets $2000 an hour instead of $400 for four, one-on-one, 15-minute, patient visits. If a company’s employee obesity rate decreases, the doctor earns a bonus. As for “insurance exchanges,” the authors compare them to online Travelocity, Expedia, and Cheap Tickets.

I like the idea of turning the Titanic around, but, well, gosh, I don’t know. Perhaps my mind isn’t open wide enough yet. Or perhaps the Extreme Enthusiasm with which this book is written undermines its seriousness.

Follow Here To Purchase The New Health Age (the future of health care in America)