Alan Weil, executive director of the National Academy for State Health Policy, interviewed Tennessee’s governor Phil Bredesen on health care, health information technology, and the challenges of changing a massive system with many moving parts. In the full interview, published yesterday in Health Affairs online, the governor talks about his involvement in the State Alliance for E-Health, which is working on privacy, licensure, and data communications across state lines, and his Cover Tennessee program, which seeks to provide low-income workers with an innovative low-cost insurance product focused on preventive care. Some discussion on TennCare and health IT is excerpted here.
Weil: Some have concluded that TennCare was a failed program. Do you share that view?
Bredesen: The idea of TennCare, as it was implemented, failed. It was always more about federal reimbursement than about changing the way health care is delivered. I come out of the managed care industry. I really believe in managed care, even today. But with the way TennCare’s managed care was structured, you could see the end coming early on. I never had any reason to believe that these HMOs [health maintenance organizations], which had really been started for the purpose of dealing with TennCare, as opposed to being ones that had systems that had experience and had capital, could be successful. In fact, they weren’t.
Maybe if people had grabbed it a little earlier on, some of these problems could have been solved. But at the time I got around to it, there were consent decrees all over the place. There were HMOs in deep bankruptcy. It just took them much more major surgery than it might have ten years before that.
Weil: To get the benefit of state-level experimentation, states need to be able to move in
different directions. But there are some who want to see federal standardization on health
information technology (IT) happen very quickly.
Bredesen: There’s a difference between the freedom to experiment with things and some level of standardization. I’ll give you an example. Tim Berners-Lee, some time ago, invented the World Wide Web. He sat down one long weekend and put together some very simple specifications for a protocol with which computers could talk to one another, and a very simple markup language. He didn’t try to invent Amazon and Google and iTunes at the same time. What he did was put some basic tools in place that were universally accepted, because it was a new field. This allowed the creative minds of the world to go out there and build something that has literally transformed the world.
When you talk about the medical sector, it’s not a start-up. It’s 16 percent of the economy. And there’s no one besides the federal government who could say, “Here’s what the standard for communications is going to be,” and then leave a lot of room for experimentation, just like the World Wide Web did.
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