To Solve Our Toughest Challenges, America’s Mayors Are Taking the Lead

America’s mayors are in the spotlight again, led by South Bend, Indiana’s Pete Buttigieg, the Afghanistan War veteran, Rhodes scholar and former management consultant who just formally announced his 2020 run for president.

Buttigieg is a Democrat with bipartisan appeal based on a track record of competent management during an era much more focused on partisanship. The community had been struggling since the South Bend Studebaker auto plant closed in 1963, leading to high rates of unemployment that lasted for decades and forced many residents out of their homes.

When Buttigieg became mayor in 2011, unemployment was still at a high 11.8 percent; there were hundreds of code-violating, vacant homes, and the downtown area was desolate. Now, unemployment is just 4.1 percent; new homes and community gardens occupy once-abandoned lots, and, as he said in his final State of the City address, “downtown South Bend is back.”

Buttigieg’s strategy was based on empowering people and reinvesting in the local community. And he had the good fortune of being in office during a time of national economic expansion. But this pragmatic approach of bringing the private and public sectors together to solve problems is one that other mayors should be looking to replicate in tackling even bigger problems, like our nation’s broken health care system.

As Buttigieg himself describes, “I ran for mayor in 2011 knowing nothing like Studebaker would ever come back, but that we would, our city would, if we had the courage to reimagine our future.” I’d argue that nothing like our past health care system will ever return and that our current model is failing us, but we can come together and work together to reimagine our future based on proven, local solutions that are actually working in many places throughout the country.

Until the government mandates away private insurance, employers are going to be in the health care business. That means employers control some of the most powerful levers for increasing the quality of the U.S. health care system — they just need to choose to pull them.

As for what that care looks like now, it’s usually low quality and high cost due to the status quo fee-for-service payment model. In a fee-for-service system, patients are charged for each individual procedure/scan/test they receive regardless of whether they’re necessary, and physicians are incentivized and pressured to order more by the health system that pays them.

Often, this inefficient approach ends in patients having to spend even more time and money making follow-up or referral appointments because their concern wasn’t properly addressed the first time. And as a result of having to do this, patients experience difficulty making quick or same-day appointments and typically spend fewer than 10 minutes with their overburdened physician.

In contrast, a value-based setting gives physicians the incentive and opportunity to focus on positive patient outcomes, not necessarily ordering tests or writing prescriptions. To do this, they spend more time discussing their patients’ concerns and how certain lifestyle factors could be contributing.

With fewer follow-ups needed, patients can usually get in to see their doctor in little to no time at all. All things considered, value-based care is thorough, collaborative, higher quality and in turn, less expensive.

So, employers can get better benefits while controlling costs. And the good news is that mayors have many different opportunities to encourage them to do this.

For starters, they can tackle the problem directly, as large employers in their own right. Kirkland, Wash., is a perfect example, having created its own high-quality (and free), full-service primary care clinic that works in conjunction with the health plan it also manages.

The city makes yearly contributions to a tax-deferred fund for each worker that can be used to pay for unreimbursed medical expenses. Since April 2015, more than $800,000 has gone into employees’ HRA-VEBAs alongside a $600 wellness incentive that provides an annual checkup, free health risk assessment and coverage for 100 percent of employee and family member health care premiums.

In addition to leading the charge themselves, mayors can use their bully pulpit to encourage employers to look beyond the old-line, increasingly obsolete fully insured plans that got us into our current mess in the first place. By going self-insured, employers can pick and choose which local value-based physicians they cover and encourage employees to visit them by waiving copays, for example. This is preferable to our current system in which large health systems are draining towns of their hard-earned dollars without commensurate improvements in health outcomes.

A “shop local” approach would much better serve all members of the community. Dollars previously squandered on health care could be used to expand businesses and create more jobs or support local schools like Rosen Hotels and Resorts did via the Tangelo Park Program in Florida.

Buttigieg spent his time as mayor focusing on how various South Bend constituents in both the private and public sectors could come together to build each other up. This very same idea can be applied to health care reform, with our country’s communities enacting local change and eventually forcing Washington, D.C., to do the same. Health starts at home, and this is an understanding that the best mayors and health care leaders realize and act upon.


Dave Chase is co-founder of Health Rosetta, which aims to accelerate the adoption of simple, practical, nonpartisan fixes to our health care system, and he is also the author of “The CEO’s Guide to Restoring the American Dream.”

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