Fixing a Broken System

Remember the “boring headline” contest Michael Kinsley launched in The New Republic 30 years ago? Kinsley had been “inspired” by a New York Times op-ed titled “Worthwhile Canadian Initiative.” Readers sent in their own favorites, but in the end nothing was deemed more boring than the Times ’s gem. (Yes, the whole affair was insensitive to Canadians. But it did become a journalistic legend.) I concede that we’re in similar territory this month with “Fixing Health Care.” It’s not exactly clickbait. But bear with us. The headline frames a debate by some of the smartest people in the field on one of the most important (worthwhile!) issues facing the United States. The debate isn’t about Obamacare; nor is it overtly political. It’s about how to fix a broken health care system currently built on a fee-for-service model that rewards the quantity rather than the quality of medical care. By one estimate, at least 35% (and maybe more than 50%) of all U.S. health care spending is wasted. We present two views on how to fix things. In “The Case for Capitation,” Brent James and Gregory Poulsen, of Intermountain Healthcare, argue for a system that would give care delivery groups a fixed payment per person per year to cover all health care services. The authors show how that could align providers’ financial incentives with the goal of eliminating major waste. In the counterargument, Michael Porter and Robert Kaplan, of Harvard Business School, say that approach doesn’t go far enough. In “How to Pay for Health Care,” they propose that providers be paid for the entire care cycle of a patient’s medical condition. That would make the whole provider team accountable for achieving outcomes that matter to patients. Technical as it is, the debate is raging inside the health care community—but it’s rarely discussed elsewhere. We hope these articles will deepen the discussion and accelerate the search for a better solution.

Fixing a Broken System

Partner Center