Dear Santa

Here’s my wish list for Christmas.

I wish that every member of Congress, political pundit, journalist, consultant and lobbyist engaged in the health reform debate is required to work a full day in a hospital emergency room.

I wish the same groups were required to read the Patient Protection and Affordable Care Act cover to cover to understand it in full.

I wish U.S. high school and college curricula included a class on “how the U.S. health system works” that everyone must take to graduate.

I wish Jeff Zients good health as he leads the reconstruction of Healthcare.gov and large numbers of Young Invincibles sign up by the end of March. And ditto success for private exchanges—probably the key to future employer health coverage.

I wish Paul Ryan and Patti Murray bulletproof vests as they take unfriendly fire from fringe partisans hoping bipartisan compromise fails.

I wish every employer that provides health insurance coverage for employees knew how much of what they spend for health care is wasted due to unnecessary care, administrative inefficiency and error. And I wish every employer that doesn’t provide coverage knows how his or her employees receive and pay for the care they use.

I wish the GOP would complete the sentence: “Repeal and replace with..?” And I wish the Dems wanting a “single payer system” would explain what they mean and how it would work.

I wish private insurance company coverage and denial policies and procedures, and criteria for narrow networks were easily accessible as public information. Ditto every hospital and health system’s severity adjusted costs, prices and outcomes, and physician ownership of facilities to which they refer patients and derive income.

I wish I could own my medical record and control access by anyone else.

I wish the SGR was fixed and a medical court system implemented to replace the current medical liability and physician compensation crapshoot. 

I wish U.S. trade policy would recapture the R&D investment made by U.S. taxpayers and consumers in drugs and devices that benefit the world.

I wish scope of practice for advanced practice nursing was expanded nationally to allow for diagnosis and treatment of common conditions.

I wish health reformers would find solutions for high-risk populations and end of life heroics so dollars spent for the rest can be appropriated better.

I wish I could buy insurance that accommodates my needs and preferences with a modest set aside for higher risk populations necessary to managing population health.

I wish we could reduce excess capacity of acute beds in communities using leftover TARP funds.

I wish funding for specialty drugs could be set aside to assure affordability, encourage use, and accelerate development.

I wish we could accelerate the transition from volume to value by eliminating fee for service incentives for most health care services.

I wish insurance premium increases were understandable.

I wish physicians were as passionate about adopting meaningful use of certified electronic health records that improve accuracy in diagnosing and treating medical problems as they are their financial systems that streamline and enhance payments from third party payers.

I wish the physicians serving in Congress knew as much about the health system—how each sector operates-- as they pretend.

I wish the focus of discussion about the Affordable Care Act in 2014 is a balance between its dual goals of reduced cost and increased access to insurance coverage.

I wish I could know what the treatment options, risks and costs are for my medical condition without having to depend on my doctor alone.

I wish we could connect health services and human services programs—public clinics, food stamps, mental health programs, environment and food supply-- in every community to reduce redundancy and improve population health status.

I wish mental health was as important to the health system as physical health.

And I wish a grassroots rational, national discussion about the value of the U.S. health system would “break out” so every individual, employer, community leader and legislator could answer the question “what are we getting for what we’re spending?”

Santa, I know you have lots of stops on your circuit this year, but if you could make this one of your first, it would be greatly appreciated!

- Paul