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QUALITY: If I Had Hammer...

You wouldn't ask a plumber to build your house. Nor would you expect a dermatologist to manage your heart disease.

The difference is that in the first case, people hire a general contractor to make sure that the job is done by right people at the right price at the right time. In the second case—well that's exactly the problem according to a recent issue brief by Cato's Arnold Kling and Michael Cannon.

Kling and Cannon begin their discussion noting that "credible estimates suggest that one-third of health care spending is wasted." They problem, as they and many others see it, is in the way health care is delivered. As treatments have become more complex, health care has become less coordinated. Patients with multiple chronic diseases see multiple specialists, with no "project manager" in charge of coordinating a patient's care and overall health. The lack of accountability and communication leads to higher costs and worse outcomes. The problem, the authors argue, is perpetuated by fee-for-service payment and exacerbated by state regulations (the Cato authors are libertarian after all...),

The solution lies in creating more integrated systems of care modeled on principles of corporate organization to lower transaction costs; promote cooperation and standardization; and can realign incentives for quality.

More than their specific vision of health care system fit for the Harvard Business Reviews, what impressed us most was how similar the authors' core arguments and ideas were to other calls we've heard for delivery system reform from across the political spectrum. Just today, Health Affairs released a web exclusive (abstract) from the National Quality Forum's Janet Corrigan and Dwight McNeill on Building Organizational Capacity: A Cornerstone of Health System Reform." Others have made similar arguments promoting accountable care organizations or medical homes (which as our colleague, Joanne Kenen once posted, might be more aptly named medical neighborhoods).

One health wonk's idea of better corporate organization is another's vision of care coordination. The emerging consensus on the means as well as the ends of delivery system reform create can lay the foundation for broader health reform. It's up to Congress and the Obama Administration to build off that foundation bringing in the necessary pieces of cost, coverage and financing reforms to create a truly sustainable health care system that works for all Americans.