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Amy Umble is health reporter for The Free Lance-Star

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Rankin: Court decision doesn’t address the real problem of U.S. health care system

Fred Rankin, president and CEO of Mary Washington Healthcare

For Fred Rankin, the recent Supreme Court decision on the Affordable Care Act was historic but wanting.

The reform law expands health insurance coverage to millions of Americans, Rankin said. But it does little to alter the market forces that have made American health care so expensive.

“We live in a world we know we need to change,” he said.

Rankin is president and CEO of Mary Washington Healthcare. Last month in a Viewpoints piece in this newspaper, he diagnosed  some of the ills of the American health care system.  In two conversations since then, Rankin touched again on the system’s ailments and offered a possible cure.

One of the problems with America’s health care system, Rankin said, is that the major players, such as doctors and hospitals, act independently to further their own economic interests.  As he put it, “There is no coordination. The economic incentives are not aligned.”

In addition, the system is entrenched—at least 60 years old—and rewards providers for “doing stuff,” such as operations, scans, procedures and lab tests, he said.

“Our whole system of American health is procedure-based,” he said.

In addition, there are increasing numbers of elderly, who are heavy users of the system, he said. As a result, health care grows ever more costly, and no one­–not the government , nor employers or patients–can sustain these costs.

An alternative would be a new partnership of hospitals, doctors, employers and insurance companies, he said. The partners would be “clinically integrated,” Rankin said, and would work together to improve care and reduce costs.

The partners would have similar economic interests, he said. All would benefit economically when the patient was healthy. All would suffer economically if the patient was ill.

“We’ve got to change a sick care system to a health care system,” he said.

To do this, the partners would focus on keeping patients healthy, especially the small percentage of chronically ill people who are responsible for a large percentage of health care costs. The partnership would focus on “driving utilization out of the system,” Rankin said.

“We’ve got to concentrate on chronic diseases,” he added.  “Prevention, wellness the management of diseases, that’s where the long-term bending of the cost curve is.”

These changes won’t be easy to make, he said, given the economic power of those who benefit from the current system. (Rankin includes his own hospital company among the beneficiaries.) But there are successful experiments taking place across the country, he added.

“I’m encouraged,” he said. “I think it’s an opportunity for doctors and hospitals and employers to make a difference in the lives of their communities.”