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Letter Submitted to the NY Times Editorial Page

User Category: BlogOn: February 20, 2019

To the editor:

Your editorial (How Much Will Americans Sacrifice for Good Health Care, Feb. 16) echoes a systemic flaw baked into our health insurance and provider systems, which is particularly invidious in public health insurance. High costs and lower quality can’t just be fixed by a single payer negotiating lower drug prices, nor would providing fewer services mean better care at lower costs. The core problem is exemplified by the arbitrary split between Medicaid and Medicare, with each providing different services spread out among many providers.

The major fix to cure our health system doesn’t lie in the false dichotomy between public and private insurance, nor does it require one payer as a response. It lies with creating single entity accountability for the total care of the individual. Whether that’s Medicare, a form of Medicaid, or private insurance, unless a single entity oversees the care of a person across the so-called care continuum – home, office, hospital, facility – and the levels of reimbursement and pay are adjusted by the quality of care and outcomes of that person, the systemic problem of high costs with poor outcomes, and lack of access, will remain in place.

In particular, enormous strides and cost savings while improving quality can be obtained by more inclusion of information from and services in the home, where people spend the bulk of their time and where many health problems originate. Discerning these problems in a timely fashion can prevent deterioration, provide lower cost treatment options, and enable people to remain where they most want to be. But the orientation of hospitals and providers has been to ignore the home in favor of the more costly options of hospital, emergency rooms, and nursing homes. Study after study indicates the enormous costs from poor coordination among many providers; a single entity tasked with managing the entire care of the individual, including their home, is the best solution to getting universal coverage at an affordable price.


Robert M. Herzog

The writer is CEO of eCaring, a healthcare management company that provides resources to manage care in the home.