Counterpoint: Task force should focus on health, not health care

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In "Task force should tackle key question" (Sept. 24), the Star Tribune's Editorial Board opined that the state's new health care education task force "should tackle all questions [its] members find relevant."

At the top of that list should be how the University of Minnesota can measurably help improve the health status of all Minnesotans.

If it chooses to be bold, the task force has an unprecedented opportunity to define what truly constitutes "nation-leading health professions education." In a nutshell, that will require much more emphasis on health and much less emphasis on health care.

Gov. Tim Walz created the task force in response to the U's "MPact Health Care Innovation" proposal to reinvent itself. That proposal calls for the Legislature to fund the multibillion-dollar cost of acquiring, building and operating a new and improved academic medical enterprise at the U.

The arrogance of the U's proposal is staggering. Minnesota struggles with rising rates of chronic disease and inequitable health care access for low-income urban and rural communities. The idea that a massive governmental investment in centralized high-cost academic medicine will "bridge the past and future for a healthier Minnesota," as the MPact tag line proclaims, is ludicrous.

Like the rest of the country, Minnesota is experiencing declining life expectancy. Despite spending more than double the average per-capita health care expenditure of other wealthy countries, the U.S. scores among the worst in almost all health status measures. Spending more on high-end academic medicine won't change these dismal health outcomes. Addressing social determinants of health (what I call "healthy multipliers") could.

The health care system's inability to prevent and manage preventable diseases, like Type 2 diabetes, may be its greatest failing. That failure manifests itself in the system's exorbitant cost (18% of GDP today vs. 7% in 1970) and in the catastrophic levels of chronic disease that now plague the American people.

As an industry, health care has gotten much better since the 1970s at keeping sicker people alive longer. This is a logical response for an industry focused on treatment rather than prevention. The rise of chronic disease, however, is a broader societal challenge.

The explosion of highly processed foods within the American diet and the emergence of "food deserts" combined with a less-active population are causal factors of the chronic disease pandemic. Health care's narrow disease- and treatment-centric orientation limits its ability to apply proven solutions to this immense population health challenge.

Managerial guru Peter Drucker once observed: "If you want something new, you have to stop doing something old." If Minnesota truly wants to improve the health of its residents, it needs to redirect funding away from hospital-centric care into vital care services that actually improve health status. Such services would include preventive care, health promotion, chronic disease management and behavioral health services.

I serve on the national board of the Healthcare Financial Management Association (HFMA) and lead a just-formed "healthy futures" task force. This task force will explore the financing and metrics associated with population health payment models. America, including Minnesota, won't change the way it delivers health care until it changes the way it pays for health care.

The billions saved by not underwriting the U's massive capital plan, for example, could fund "UP4C" (universal primary, prenatal, post-natal and palliative care) for several years. Imagine the uptick in health status this type of "Heathy Futures" investment could achieve in Minnesota's low-income communities.

Improving the health of the state's residents would actually lower the state's total health care costs. It also would increase productivity, expand human potential, reduce inequity and improve individual well-being.

Minnesota has a well-earned reputation for enlightened health policy development. Jan Malcom and her task force compatriots can enhance this reputation by reimagining and reinventing how the U prepares health care professionals to create better population health for all Minnesotans.

To accomplish this, the task force must see beyond the U's razzle-dazzle proposal. They must undertake the hard, meaningful work of advancing holistic, interdisciplinary and interprofessional population health training and programing within the U's massive health sciences enterprise.

More than anything else, Minnesota's long-term economic prosperity and well-being depend upon the state of its residents' health, not the grandeur of its academic health care system.

David Johnson, a native Minnesotan, is the CEO of 4sight Health, a boutique health care media and advisory company. He is the author of "Market vs. Medicine: America's Epic Fight for Better, Affordable Care."