Opinion
Financial transparency is essential to creating best possible health system
LETTER — Posted Feb. 25, 2008
In the debate about the promises and perils of a single-payer health care system for the United States, I have been surprised to hear so little about a vital function our present system cannot provide: priority setting by democracy.
Currently, financial decisions that have major impact on the dynamics and capacity of health care delivery are made strategically by market-driven business entities, the processes of which often are private and the data usually proprietary. This necessarily interferes with any effort by physicians, patients or their advocates to set or enforce a meaningful agenda for health care at the state or national level. Accountability to the true needs and priorities of our society is nominal.
No system guarantees perfect decisions, but in a single-payer system the decision-making process at least would be in the public record, open to scrutiny. Obvious examples include how reimbursement rates are set, premiums calculated, formularies structured, covered versus noncovered benefits determined, and investments in health infrastructure allocated. Without this information, our discourse about health care goals is purely academic.
Just as a free press has been essential to protecting our political vitality, a transparent health care financing system will be essential to optimizing the application of finite resources for our medical common good.
Andre Gerard, MD, Healdsburg, Calif.
Note: This item originally appeared at http://www.ama-assn.org/amednews/2008/02/25/edlt0225.htm.
