Perspectives from NEJM: Flaws in basic health plans, post-2012 scenarios, seeing eye-to-eye with patients

The New England Journal of Medicine has perspectives on a variety of health policy topics today.

Balancing Coverage Affordability and Continuity under a Basic Health Program OptionThe ACA's incremental approach to near-universal coverage has raised concerns that changes in income, employment, and family composition will shift people into and out of different coverage arrangements over time. ... To address concerns about churning, some states are considering adopting a Basic Health Program (BHP).  ... Whether by design or through attrition of willing plans and providers, however, operating a BHP with provider networks different from those of both Medicaid and the exchange could further stratify the low-income and moderate-income population into three separate classes of coverage (John A. Graves, Rick Curtis and Jonathan Gruber, 11/30).

2012 -; A Watershed Election for Health Care 
Three possible federal electoral outcomes seem most likely. All assume that the Republicans will retain control of the House of Representatives. ... Under the two most probable scenarios, the health care system probably wouldn't change fundamentally for at least the following 4 years. That means that the proportion of Americans without insurance will not decline significantly; under the third scenario, the proportion could even continue to increase at pre-ACA rates. Governmental leadership to control health care costs through fundamental health system reform will also flag. And by 2020, 20% of Americans may be uninsured, even as 20% of our gross domestic product is devoted to health care (Dr. David Blumenthal, 12/1).

The Four Habits of High-Value Health Care Organizations 
[E]xperience suggests that not only do new delivery models -; for example, integrated networks -; not necessarily live up to their promise, but they are surprisingly difficult to transfer, even when successful ... Although high-value health care organizations vary in structure, resources, and culture, they often have remarkably similar approaches to care management. Specific tactics vary, but their "habits" -; repeated behaviors and activities and the ways of thinking that they reflect and engender -; are shared. This is important because experience suggests that such habits may be portable (Richard M.J. Bohmer, 12/1). 

Seeing Eye To Eye
Interactions with patients are often abbreviated, conducted from unequal levels, and unavailable for observation, feedback, and professional development. It is ironic and emblematic that we sit down in front of our computers, getting comfortable for our chart encounter, whereas with our patients, the reason we're here, we generally position ourselves for a quick exit. We can do better. I suggest that we move our computers to standing level and supply all our ward teams with portable stools. At a minimal cost, we would simultaneously encourage shorter notes, improve education and feedback, and promote longer, more meaningful patient interactions (Dr. Daniel R. Wolpaw, 12/1).