Yesterday, Schweitzer Fellow for Life Rushika Fernandopulle, M.D., M.P.P. shared his thoughts on two major obstacles when it comes to meaningful health care reform. Today, he tackles a third, making a convincing case for major change in how health care is delivered.

To truly address the cost of health care, we need to fundamentally change how we deliver it. Simply shifting costs by raising out of pocket costs for consumers, or implementing more traditional utilization review — for instance, questioning each MRI–does not work. We need a much more fundamental change in delivery.  Experts estimate that 30-50% of what we currently do in health care is waste; we need to systematically harvest this value to reduce the cost of care. 

And finally, I believe the only way to do this is to create the environment for real innovation in how we pay for and deliver care. While the last 50 years have brought us miraculous new drugs, tests, and procedures, the way we deliver them to patients has remained frozen much as it was decades or even a century ago.

Think of what happens when you go to a doctors office or visit an Emergency Room — the process is rife with potential errors, disrespectful of your time, and ends up costing much more than it needs to. All these problems are even worse for the poor and vulnerable, who too often when insured are used by unscrupulous providers to generate more income, with little or no benefit to the patient themselves. 

Clearly action here will create some losers — providers who are currently providing unnecessary care, health plans that harvest unnecessary administrative costs, drug and device companies who charge monopoly prices without adequate regulation, lawyers who profit from frivolous and ridiculously large tort claims.

We need the courage to remember the job of the health care system ought to be to serve its customers — us, the consumers and patients — and not just those who profit from it. 

History shows us that health reform is a once-in-a-generation opportunity. While expanding access for the uninsured is a worthy goal, I believe we need to focus on several other important issues such as reducing other barriers to care, and making care more affordable by fundamentally changing how we deliver it.

It is only by doing this that we can create lasting changes that will sustainably improve health and health care for ourselves and our children.