The health care industry has survived economically by cross-subsidizing margin shortfalls in one activity with the revenues generated from others. But the very existence of these cross-subsidies is symptomatic of deep flaws in the health care reimbursement system. As we move forward we need to be mindful of two principles that must be at the heart of any fundamental health care reform: “no margin, no mission” and “if you can’t measure it, you can’t manage it.” As the era of health care cross-subsidization ends, these principles must guide our actions.
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