Improving Healthcare to Deliver Better Quality Care at Lower Cost

The day's final panel centered on healthcare innovations that will improve the quality of care and lower costs, as well as the implications and possibilities surrounding the legislative debate on coverage and access. This conversation was moderated by Julie Rovner, chief Washington correspondent for Kaiser Health News, and featured American University President-Designate and former U.S. Secretary of Health and Human Services Sylvia Mathews Burwell, American Enterprise Institute Chair James Capretta and Atul Gawande, executive director of Ariadne Labs.

While much of the discussion in the public sphere and in Congress has centered on “repeal and replace” of the Affordable Care Act, Gawande urged his fellow panelists to take a step back and examine the larger picture. “What is the goal from a healthcare point of view about what we’re going to do with healthcare?” he asked. “In what way are we making people’s lives better or the healthcare system, or a long-run approach to healthcare better?”

Capretta identified three overarching goals for healthcare reform. The first, he said, should be a better understanding of the distribution of financial responsibility and societal responsibility. Second, he said, was to achieve a level at or near “100 percent enrollment in health insurance.” Capretta said his third goal is “to bring discipline to the system,” which means identifying and making available low- cost, high-value options in healthcare.

Burwell outlined her own objectives for improv- ing the healthcare system: access, affordability, and quality, all in a “fiscally responsible way.” Burwell added that we must make sure we consider the entire healthcare landscape: employer-based care, Medicare, Medicaid, and the marketplace. Burwell cautioned that proposed cuts to Medicaid, in particular, would have a “devastating” impact on low-income, elderly, and disabled Americans.

Capretta noted that demographic changes and rising healthcare costs are creating a fiscal pressure that will need to be addressed. “We’re well into the retirement of the baby boom generation,” he said. “And within five or ten years the fiscal situation is going to get pretty bad. So something has got to give.” Gawande agreed that as a nation, we should strive to expand healthcare coverage to include the “20 or 30 million people” who lack it. Additionally, he said, we must transition to a system of portability, where healthcare coverage is not tied to employment. “Healthcare is [important] for every individual and their families,” Burwell agreed.

The panel ended with a discussion of major misunderstandings about the healthcare system and how to best educate the public, policymakers, and people in the health systems themselves.

All three panelists agreed on the critical need for greater public education and engagement to build the political will for change and ultimately to produce policy that is responsive to Americans’ needs.