Beginning with Nixon there has been what appeared to be serious talk to address health care and yet here we are thirty plus years later and still struggling over the issues.
The lessons of the Clinton administration were ignored, the Obama administration started on the wrong foot by putting the design in the hands of the Democratic leadership and today we sit with the likelihood of a half baked piece of legislation that does not reform health care and does not address the fundamental problems that cause our system to be overly expensive and under optimized in terms of the quality of care. Or, there will be failure again and nothing will happen.
I remember sitting in the White House in the 1990s at a small conference table with Ira Magaziner on my right. At the time he was heading up the Clinton health care initiative. The stated purpose of the meeting was to get input from business on health care reform. We listened and I started asking some questions, some question they apparently didn’t want raised and after my third attempt I was effectively excluded from the discussion and not called upon again to speak. That gave me a pretty good clue as to where this was going at the time.
In the 1980s I was a part time consultant for the old Office of HMOs and I saw first hand how they funded plans with inadequate leadership or supported by doctors who saw their participation as a way to preserve business as usual within an HMO. I was on the board of directors of four different HMOs and all went out of businss in a few years becassue of the above and the resistance of the public to “managed care” and the controls, limitations, and oversight that goes with high quality, cost efficient health care.
The Obama effort is not much different. This administration is trying to change virtually every aspect of health care all at once and largely by allowing politicians and their staffs, many with little experience in the real world, to have at it while labeling any counter views as obstructionist. This time something is likely to pass and be implemented simply because there is a “get something, anything done” attitude. The danger is that it is the wrong something and it will take a decade for us to figure that out.
What do they miss in trying to reform healthcare?
- They do not understand the emotional aspect of health care and that buying health care is not like any other purchase that may be subject to market conditions and objective decisions.
- The do not understand or do not want to tackle the fundamental problems that are driving health care costs and rather focus on the ills of insurance.
- They fail to understand and then educate the American people on the realities of health care in terms of cost/benefits, quality, efficiency, risks, etc. We have yet to establish a level of personal responsibility for health care among Americans.
- They do not understand or ignore the fact that all aspects of health care are connected and therefore do not attack the problem in a logical order or with an understanding of the consequences of changing this or that element.
- They immediately politicize the process rather than use the considerable expertise in America, some of it within each administration, to assess the various elements such as quality, health status, cost, administrative efficiency etc. followed by specific recommendations that truly address the problems.
In short, each administration tries to make sausage that will be a delight to each individual palate and in the process appeals to no one. History has proven that it is inadequate to simply say there is a problem and to scapegoat this or that group trying to solve that problem.
Hey, everyone loves me, I come in twenty varieties
The reality is that most Americans cannot see a problem, they pay their premiums in many cases somewhat invisibly through payroll deductions and they receive health care with little financial stake along the way. They do not know or apparently care about the quality or appropriateness of that care, they are still fixed in the mindset that they are going to the best doctor in the business and that any questioning of his or her treatment is mere interference driven by a desire to protect some CEOs bonus, perceptions by the way driven by the very politicians who say they want to reform health care in America.
And that is why we may never truly reform health care in America. Even if some legislation passes this time, because it is not the right legislation, we will be far worse off in ten or fifteen years than we are today, and far poorer.
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