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Giving Up on American Innovation?

By Dr. Evan Saulino
. 2 Comment(s)

Governors from across the nation met and talked about health care - particularly about Medicaid - this week at the National Governors Association meeting.

Some, like Mississippi Governor Haley Barbour and Wisconsin Governor Scott Walker (now famous for his bulldog approach trying to take away collective bargaining rights from public employees because their health benefits are too expensive) argued that they need more flexibility in Medicaid to limit enrollment and services - so they can balance their state budgets.

Cut the problem out of the budget, and the problem is solved apparently.

It’s a dark assessment to believe the only solution to rising health care costs is to ration health care, benefits, and services.

Advocates of this singular strategy make me wonder if they’ve given up on the idea that we can do innovative things in our states and communities to improve health care quality and outcomes, and that we must learn how to control health care costs to have a sustainable economic future.

Contrast that strategy with the statements of Governor John Kitzhaber – a former ER physician representing my state of Oregon.  At the meeting, he requested more flexibility for states as well, but as laboratories for ideas and innovation that could find better ways to manage health care costs in the long term, while the states tested and measured the best ways to produce better, higher value care for more Americans.

I’d like to believe the Doctor is right…that innovation - rather than amputation - is the way out of our health care crisis. 

The fact is there are a whole lot of ideas about how we can control health care costs while we improve health care outcomes.

State governments should be jumping in to play a big role and helping to foster and implement these innovations and efficiencies - in payment, administration, care delivery and coordination.

Just a few “tip of the iceberg innovations” that deserve special attention:

  • In his recent New Yorker article - The Hot Spotters – Dr. Atul Gawande highlights community based approaches that produce superb outcomes with the highest cost patients.
  • Citing some of the overwhelming evidence that areas with more robust primary care systems have citizens with better health and lower overall health care costs, the Rhode Island Insurance Division mandated private insurers nearly double the amount of their paid medical expenses that go towards primary care.
  • Some states, like North Carolina, have fostered a more coordinated Medicaid care system that has produced hundreds of millions of dollars in cost savings. As evidence mounts that patient-centered medical homes produce better care at lower overall cost, other states, payers, and health systems are beginning to develop new payment structures to support and implement these cutting-edge models of care more widely.
  • Following the maxim that in crisis there is opportunity for change, some states (like my own)  are trying to make the lemons of a tough budget into lemonade – discussing ways to achieve Medicaid savings through system and care transformation rather than simply resort to chopping people off the program.

Offering an opportunity that “States-Rights” advocates should jump at, President Obama voiced support for the bipartisan legislation - introduced by Senator Wyden (D-OR) and Senator Brown (R-MA) - allowing states more flexibility to start innovative models of care, payment, and coverage starting in 2014 (rather than 2017 as in the current law). 

In other words, in 2014, if states think they can do better than under current Medicaid or Affordable Care Act rules, they can apply for an “exemption”. They then have 5 years to demonstrate they can implement other, better ways to expand quality coverage without driving up health care costs.

For example, say a state doesn’t like the “individual mandate” and has a different idea – they can try it.

Or say a state has support for a “single-payer” as the way to finance health care – they can try it.

Or say a state wants to pursue Medicaid care coordination improvements and payment reforms that they think can be supported with evidence and will produce better results at lower overall cost – absolutely, they should get a chance to try it, right?

These experiments could yield helpful lessons and help us drive innovation nationally – resulting in long term cost savings for public and private budgets and better health for more Americans.

I believe that Americans can accomplish anything if we put our heads together. 

We must take this opportunity to try. 


Share Your Comments


  1. Christopher Hughes

    Excellent post.

    Don't you just shake your head in disbelief at people who don't want our health care system to change because they don't want any "rationing?"

    Rationing is here in America and it is very ugly.
  2. Brenda


    Well expressed!

    I see the rationing every day amidst the current dysfunction of our system, which MUST change. Even those WITH insurance are struggling. Cutting people out of insurance coverage is a surefire way to ASSURE we will have rising healthcare costs and many more ER visits, but extremely poor discoordinated care.

    I am exhilarated by the opportunity to be a part of such potential for change-- to be able to think outside the box and innovate! So glad other states are also starting to come up with creative solutions.

    Let's GO OREGON!

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