Total Cure: The Antidote to the Health Crisis

One person with a plan can inspire great change.

The person? Harold S. Luft, Director of Palo Alto Medical Foundation Research Institute and Caldwell B. Esselstyn Professor Emeritus of Health Policy and Health Economics at the University of California San Francisco.

The plan? Total Cure, published last year by Harvard University Press, summarized in Dr. Luft’s words: “To change the health care system, combine the collective action potential of government with the flexibility and innovation of well-designed markets.”

In Total Cure, a reboot of the health care system is presented, focusing on incentives, constraints, and more choices for patients and providers. Dr. Luft draws on over 35 years of economics and medical research, and of listening to patients and providers. He calls his blueprint for reform SecureChoice.

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“SecureChoice establishes a single universal coverage pool, or UCP, insuring hospitalization and chronic illness—roughly two-thirds of medical care expenditures. Financing can be through taxes or employer contributions. Inpatient care is paid directly by the UCP, much as Medicare pays hospitals. The UCP, however, pays care delivery teams, or CDTs, composed of physicians and hospitals voluntarily taking responsibility for the quality and costs of care during an episode. They will decide how to allocate funds amongst themselves to achieve the best outcomes. Unlike Medicare, which sets its payments on average costs and arbitrary budget constraints, the UCP bases its payments on the costs of CDTs achieving superior outcomes. SecureChoice is about value, not just cost containment.

Patients freely choose their primary care provider without being locked into health plans. The pool provides monthly payments to offset the costs of managing chronic illnesses. Costs not paid by the UCP are largely associated with: (1) minor acute problems not needing true insurance—but which may receive income-based subsidies, and (2) higher costs reflecting provider-determined fees and practice styles. Physicians can practice however they choose, but may find their patients asking why premiums or fees for their services are worth the extra cost.”

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While I am not an expert in the intricacies of the US health care system (I lived in Canada until 4 years ago and I trained in bioinformatics, not economics), what I’ve read about Total Cure from the perspective of an informed patient with a chronic condition makes a great deal of sense to me.

I support this person and his plan, and I think it can impact meaningful change.

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