TennCare Reform Needs Market Forces
By Trapper Michael Former AOL chairman Steve Case has a vision of consumer-driven health care and $500 million to realize it. Case last month introduced Revolution, a health, wellness and resort company with a comprehensive consumer-driven health care element. Former AOL chairman Steve Case has a vision of consumer-driven health care and $500 million to realize it. Case last month introduced Revolution, a health, wellness and resort company with a comprehensive consumer-driven health care element. As Tennessee faces its own health care changes, it is important to ask: What could a consumer-driven health care revolution do to improve Tennessee’s hobbled TennCare system? Not much, at first glance. Case’s initial investments include a media company with programs discussing wellness issues and an exclusive resort club. Revolution, it seems, is for the rich, but is that all the consumer-driven health care movement will ever be? A decade ago, many opponents of the shelved “HillaryCare” health plan pleaded for a health care system in which the consumer, rather than government and insurance providers, was king. Supporters of consumer-based health care argued that, by offering service options not bound by government regulations or insurance mandates, the subsequent competition would result in improved quality at a lowered cost. By 2004, Congress authorized Health Savings Accounts – tax-sheltered accounts similar to IRAs, which spend like checking accounts – that encourage people to take control of their own health care dollars. The health insurance industry has adapted by combining very popular high-deductible health plans with HSAs, and ventures like Revolution are now rising to facilitate health care consumerism. How can this help Tennessee? Case’s elitist consumer health venture is irrelevant to those cut from TennCare. In order to succeed, it is vital that market-based health care offer solutions geared toward those who need quality, affordable health care the most: the underinsured and uninsured. Fortunately, Nashville has the institutions and people to breed innovative and inclusive approaches to public health problems. Health care dominates Nashville industry, with juggernauts like HCA, Caremark and Community Health Systems. Sensing this, the Owen School at Vanderbilt is building a health care concentration into its MBA program. Tennessee’s two brightest political stars, Phil Bredesen and Bill Frist, first gained recognition for their pioneering work in the health care industry. As Bredesen and company wrestle with TennCare, they would be wise to consider consumer-driven health care and its future. HSA enrollment reached one million earlier this year and continues to grow. Meanwhile, there is a proliferation of Web sites and other services making health care consumers more knowledgeable and comfortable with the health care process and available service options. The consumer-driven health care movement is afoot nationwide and will offer Americans unprecedented levels of choice and opportunity in medicine at lower prices in the near future. Why should Tennessee’s poor and uninsured be left out when that time comes? The last time state leaders went to the drawing board to create a model Medicaid system, the result was a costly socialist-style model that exhausts the state budget and proves inadequate at properly serving the individuals enrolled in the program. Now it is time to turn the other way and move towards a flexible, patient-sensitive approach. Then all citizens – even the poorest – will enjoy quality, efficient medical services focused on their needs as health care consumers. While Case’s initial vision for consumer-based health care may discount the poor and uninsured, Tennessee’s vision must embrace them. With proper anticipation now during current TennCare reform efforts, state leaders will be in a unique position to put Tennessee’s Medicaid program on the fast track to the consumer-driven marketplace.