Column: Accountability – The General Public

This series titled “Column: Healthcare Accountability” is sponsored content from our partners at Axene Health Partners.  AHP offers highly specialized health care actuarial and consulting services across a number of states.  We have curated this content because we think it adds value to the work our readers are engaged in.  As always, we welcome your feedback on this series.




The general consensus is that the U.S. health care system is too expensive, provides less than desired levels of quality, and does not effectively cover enough of the country’s population. While deficiencies in quality and coverage aspects of the system are pressing concerns. The escalating cost of the U.S. health care system is a threat to the federal government’s ability to meet its future fiscal obligations.

For example, to put Medicare on a sustainable path given current levels of spending and life expectancy would require a 15% payroll tax, according to the Affordable Care Act’s (i.e., ACA) architect and MIT health economist Jonathan Gruber.

Richard Nathan of the Rockefeller Institute hypothesizes that there are two main approaches to reforming the U.S. healthcare system. The first emphasizes government action to integrate services and in other ways increase the productivity, quality, and efficiency of care. The second approach seeks to leverage the power of consumers to negotiate better costs, quality, and efficiency in the U.S. health care system. While it is beyond the scope of this article to debate the positive and negatives of either approach, it is fair to say that they both have promise. Both approaches also have in common the need to obtain “buy-in” and support from the general public. A consumer-directed approach would need the active and enthusiastic involvement of the public acting as consumers to work. Likewise, a provider-value approach, would require the acceptance, or at least acquiescence, of the general public in regards to limits on provider access and consumer choice.

A health care reform effort not supported by the public will fail for practical, economic, and political reasons. For example, the broad implementation of managed care practices in the U.S. in the 1990s led to a significant slow-down in the rate of increase in the cost of care in the U.S.4 Unfortunately, the general public and most health care professionals were not happy with managed care practices. In response to provider and consumer dissatisfaction, many managed care organizations dropped or loosened the business practices that allowed them to successfully control the cost of the care, i.e., provider risk contracting, limits of patient access to providers, and utilization management practices. The pullback on successful managed care practices led to a significant rebound in the rate of increase of the cost of care by the early 2000s.

To date the general public has not shown a great deal of enthusiasm for accepting any real responsibility or limits when it comes to health care spending in the U.S. This will need to change regardless of the route health care reform takes in the future. Simply put, the status quo is not sustainable, and the American public must balance its expectations when it comes to access, quality, and cost to ensure that we meet our goal of universal high-quality affordable health care in the country.

Continue reading the column here