Altoona doctor Zane Gates will give a "TEDx Talk" today in Philadelphia to employees of Johnson & Johnson, detailing ideas he hopes may ultimately revolutionize the health care industry.
TEDx talks are a category of speeches given under the aegis of "TED" - a 30-year-old nonprofit organization whose name is an
acronym for "Technology, Entertainment, Design" - whose mission is to spread worthwhile ideas from "the world's most fascinating thinkers and doers," according to the TED website.
Gates was invited to address the Johnson & Johnson workers on the suggestion of a company employee - a son of a former Mirror editor, Margaret Moses, Gates said.
"He has an interesting idea/model to share," said J&J spokeswoman Nadia Mostafa. "The goal is that people see the enormous challenge of access to care in a new way."
As reflected in the Pennsylvania Community-Based Healthcare Program law passed last year, Gates' model targets the working poor - those who don't qualify for Medicaid but who can't afford regular insurance.
His model starts with care, and builds insurance to accommodate it, rather than the other way around, which characterizes the existing health care model, he said.
In Gates' model, the government helps hospitals subsidize community clinics, which provide full-service primary care at no cost to qualifying users.
Those clinics operate without insurance, which frees up all staffers - doctors, physician assistants, nurses, receptionists - to focus on care, emphasizing prevention of illness and monitoring of chronic conditions.
Nurses in normal primary care offices now spend 50 percent of their time on insurance administration, while front-office staffers spend 88 percent of their time, Gates writes in papers he co-authored with Mark Agee, a professor of economics at Penn State Altoona
"We believe that sick people need no barriers for engagement with the health care profession," he wrote. "Deductibles and co-pays do limit engagement, especially in lower income patients."
Hospitals benefit from this kind of primary care setup because patients don't go to emergency rooms for treatment of minor problems best treated through primary care or for treatment of chronic conditions that have spiraled out of control for lack of regular attention, according to Gates.
The Gates model includes a low-cost insurance plan for hospitalization that covers only non-routine problems, those that can't be predicted for individual patients.
The insurance setup in the current health care system is misguided, in that it covers routine procedures and tests like mammograms and diabetic office visits, which are entirely predictable as necessary procedures, according to Gates.
That has led to claims by 70 percent of health insurance policy holders, leading inevitably - based on actuarial formulas designed to protect insurance companies - to premiums that
go up radically every
year, making health
plans unaffordable, Gates argues.
Fundamentally, all insurance is designed to cover claims made by only 10 to 20 percent of policy holders, he said.
"Imagine if 70 percent of all people who bought car insurance wrecked their cars, or 70 percent of insured homes burned down," he wrote. "The price of car and homeowners insurance would be unaffordable."
TEDx talks like the one that Gates is giving today give "communities, organizations and individuals the opportunity to stimulate dialogue through TED-like experiences at the local level," with coordination independently of the TED organization, according to the TED website.
Johnson & Johnson uses TEDx to awaken "creativity, engagement and passion" in employees, in order to help the company grow, according to Nadia Mostafa, J&J spokeswoman.
Speaking of his model, Gates said, "I think this can work for everybody."