Tonight's mini-med school lecture included no PowerPoint slides. Instead Dr. Hal Luft, Director of the Palo Alto Foundation Research Institute and an emeritus professor at UCSF, led a town-hall discussion about better financing models for health care.
Luft's insights are well presented on his web site Secure Choice and in his book Total Cure. His core idea is to make much more intelligent use of the data that is already coursing through the health care system, so that people have a genuine sense of where the best health care is taking place. Right now it's fairly easy to inflate outcomes through such tactics as mostly treating healthy people.
In Luft's alternate (and better) universe, there would be sufficient analysis of data so that the true high achievers would come forward. These groups would be rewarded, and also compensated for taking additional time to meet with patients (as Luft pointed out, we overpay for procedures and underpay for time.) There would also be much stronger incentives to coordinate care at the primary care level; such incentives are almost non-existent today.
As Luft explains here, he is attempting to harness the the collective action power of government with the innovation of well-designed markets. Several times he pointed out that he's "just" an economist, with an aversion to considering the "little p politics" that infects health care organizations and the "big P Politics" that infect Washington. So his model is admittedly theoretical more than real-world.
I'm not sure how Luft's approach compares to others on offer, but it was impressive in its breadth and comprehensiveness. The health care debate usually falls into two camps: let the government take over, or let the market rule. Luft's approach--to combine the best of both worlds--seems both blindingly obvious and extremely refreshing.