The Nuts and Bolts of Reform Proposals

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Universal adoption of electronic record-keeping.

Hospitals and other health-care organizations are transferring paper records to electronic ones, but in a piecemeal fashion. Once an electronic system is in place across the country, patients would no longer have to repeat their medical history or recite their prescriptions (what they can remember, anyway) to each new doctor.

This would mean lower administrative costs, partly by eliminating unnecessary repeat tests. But it could also potentially prevent life-threatening medical errors. "It would save money over the long run if people had electronic medical records and if everybody had some sort of medical home in charge of medical care," said Linda Fentiman, professor of law at Pace Law School in New York City. "But it might take 10 years for that to be implemented."

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Greater emphasis on preventive care.

The goal here is to devote more money to programs to combat preventable problems such as obesity and smoking-related illnesses, and to encourage vaccinations and disease-screening tools such as mammography and colonoscopy. "This is one of the reasons that managed-care health-care costs are so high," Fentiman said. "Most people change plans pretty frequently, so if a managed-care company knows it's only going to be covering people for two to three years, it doesn't have the financial incentive to provide high-quality preventive care. We don't yet have a system that will pay physicians for taking good care of the patient over the long run."

Effective management of chronic illness is another piece of the puzzle, said Mary Mundinger, dean of the Columbia University School of Nursing in New York City. That means steps like making sure that people take their blood pressure medications, cut down on salt, and exercise to prevent heart attack or stroke -- problems that will end up costing billions to treat. "Personal responsibility for one's health care has not been built into the American system before," she said.

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