The Future of Healthcare

The Executive Director of the National Governors Association talks about what the future of healthcare in the United States might look like.

Raymond Scheppach: So what is that visual lookout? It used to be first off, we will have fairly robust quality measures, hopefully their output measures, satisfaction measures or whether it's a number of process measures. Second, it's -- hopefully we've got electronic health care records for everyone. We've exchanges that are operational, and they have most of the required data that we need. Third, we've got crisis, and we have in fact ay public and we'll have a linkage between quality measures and crisis, and we've got certain safety measures in particular with hospitals. These measures would be available pretty comprehensively in hospitals, nursing homes, laboratories, physicians and so on. And those measures would be accessible or would be reliable, would be timely, so that people could get out of their average and really pull up their information, relatively easily. Within that reform context and what do we need the federal government to do. It seems to be that above normally, a state advocate. In this particular area, we do need the federal government to set at least the quality core standards for quality. And second of all, we need the federal government -- it seems to me to set the standards for our electronic health care records. It maybe, we want to pull out a little bit of flexibility for states to experiment, but largely, seems to me this is a function of the federal government. What will states do? Sort of layout four or five things, that will be -- they are responsible. One is that government probably continue to run programs from our income. Individuals, regardless of whether we add to their Tax Credit or a Voucher or expansion of a government program. It will probably be state administered. Second, these are all, I think, in the standard setting area, because this has got to be an evolving process, and I think states actually experiment much better than Federal Government, does, and at least when they screw up something, go back and fix it, the following year, where the federal government says, we can't touch that until -- we have to reauthorized for years. So there will be a limited role for quality in IT standards. They will, however, be enforcer, even if you had federal or states standards, and it seems that the role of states is to enforce, make sure that those standards and quality measures are reliable, timely, and accessible. And the fourth function seems to me regarding to ensure portability in the health care system, choice and portability. Now what's the role of our public-private entities? It seems to me there is a couple of awareness where a private sector and public sector have to get together. Now the first one is, of course electronic health care exchanges or records. I think, these are probably going to have to be done on a state by state basis. However, I think that has got to currently be a national system. But I could foresee where you have public-private entities even with board members and majority of which come from private sector helping to set those particular standards and finding out how you in fact certify who is a legitimate to access that particular information. They would probably set particular transaction fees perhaps, and they would probably contract out who in fact would be the private sector group that manages part of the industry. I think we've got hard work to do in that area in terms of what is the business model, however. It seems to me that those societal benefits are greater than the benefits to any particular firm and therefore who's going to fund it and what the business model is, sustainable. I think we need some more work, but the government role, it seems to me, ought to be fairly narrow. We also probably need alliances or connectors, several in large states, maybe one in smaller states, much like the Massachusetts component, where your matching providers and individual consumers, so that you have a choice and again you have a portability, you can -- all of the programs could go through that small business, anybody else that in fact vulnerable through the alliance because of the choice, it would have a great benefit particular in urban areas as people move from one part to the other. They can actually keep their health care with the same entity. In fact, I suspect that included pensions with health care to put those both in an entity, it would have a lot of advantages. So two components in terms of public-private partnerships.