What began with great hope and good intentions to avoid the reform mistakes of the past is now going badly. Sadly, what we are watching in Washington is a bunch of very smart people trying to hold a handful of Jell-O that has not quite jelled. It is not a pretty sight and they are making a very big mess.
As of today, the two or three Democrat plans seem to be focusing more on increasing access for the uninsured and the underinsured, and benefit portability, all of which are major problems. However, these provisions translate into higher costs, a result we do not need. Healthcare in America is already the most expensive in the world, by any measure. These costs affect the cost of our goods and services and therefore our ability to compete in global markets.
The Republicans seem content to argue that additional tax credits and cuts, while unleashing the forces of the free market, will solve the problem. They have yet to put forth a wide-ranging solution, unless you consider a four-page summary with no mention of costs or savings, a comprehensive alternative. There are some exceptionally bright and creative minds in the GOP but at this point in the “debate,” they seem to be looking forward to the next election cycle. The Democrats, with their own political agenda, are wrong in their approach and the GOP appears to be running away from introducing thorough proposals that reflect the innovation and creativity that this debate so desperately needs.
Earlier today, on NBC’s Meet the Press, Senate Minority Leader Mitch McConnell, R-KY, refused to concede that there is a problem with quality and patient safety. This, in the face of overwhelming evidence to the contrary. His source of all knowledge on this issue: some public opinion poll in which the majority of those surveyed believe our “system” is the finest in the world.
I do not believe that President Obama’s current effort will achieve sustainable change – improved access, enhancements in quality of care and patient safety, and better operating efficiencies – without attacking the structural deficits that plague America’s healthcare system, which is not a system at all but just a series of unconnected silos. These operating silos exist at the macro level and within most individual health systems and hospitals in the U.S. These structural defects create costly inefficiencies and are responsible for far too many preventable deaths and serious mistakes that prolong hospitalization or lead to permanent disability. That there is a serious problem with quality and safety is precisely why so many health systems and hospitals are focusing resources on this critical challenge.
What we are seeing today in Washington is an attempt to reform the existing silos, the boxes inside of which all of us in the healthcare provider segment toil. Sustainable change will require that we take a step back and look at the way healthcare is delivered in this country. There is a real opportunity for innovation and creative redesign. But let’s face an important reality – that structural reform cannot happen in five months, especially since Congress will recess for the month of August.
We must begin with the way we educate our physicians, hospital leaders, nurses and other ancillary personnel, tasking them to create new models for the delivery of care and to establish new standards of performance and accountability.
Now to an important underlying problem: entitlement. Americans want what they want, when they want it and that includes access to healthcare. Any reform measure that appears to restrict access – regardless of how medically or morally sound – is viewed by many Americans as rationing. That is one reason why the thorny issue of who really pays for the healthcare in this country is a debate we consumers always want to push off for another day. After all, when you have group health coverage – for which most American’s do not bear the full cost – or the existence of safety net hospitals that will provide care for modest or no payment, there is little motivation on Main Street to get too interested in structural reform. Hence, the recent poll numbers on the public’s declining support.
I admire President Obama’s vision and his idealism, his desire to deliver change that will improve our lives. However, Change You Can Believe In can quickly become nothing more than hollow words that breed more voter cynicism if the change you adopt creates more problems than it solves or if there is no discernable improvement in the costs, quality, and safety.
Of equal importance is our current economic mess. Now is NOT the time to add significant new costs to healthcare when one of the goals of reform should be to reduce costs. You can further reduce payments to providers. Or, you can eliminate payments for certain services. But wouldn’t these approaches lead to de facto rationing? Are these reductions in reimbursement just “budget neutral” offsets? Is it really cost reduction if hospitals and physicians write off the differences between what they bill and what they are paid by the government or managed care companies?
What is going wrong with this noble effort for healthcare reform? Overall, it is timing. In one sense, the time is right because the President and his advisors know that if they do not get a bill before year’s end, they will lose momentum. The closer we get to the mid-term elections, the stronger the influence of the lobbyists and special interests.
Finally, the underlying problem is the corruption of honest political debate and the act of governing. Candidates are elected based on sweeping themes and inspiring rhetoric. They take their oaths of office and then immediately return to the campaign trail mentality. What happened to governing?
Scott McClellan, President Bush’s press secretary who was forced out following the embarrassing Valerie Plame misadventure, argues that American politics on the national scene has deteriorated into the permanent political campaign. Issues are kicked down the road; laws that are passed more often than not are shaped by the immediacy of the next election cycle.
President Clinton’s feisty White House political team introduced permanent campaign mentality to governing. President Bush and his political advisors perfected this concept. Now, President Obama apparently is working to improve the perpetual campaign playbook while pushing bold change – on a tight schedule.
We have arrived at a very bad place in our history. The permanent political campaign approach to governing – where political gain is more important than good policy or the common good – is driving all aspects of our public policy discourse, including the effort to reform healthcare and will further push our nation into the hole of mediocrity. I am not optimistic that Congress can achieve comprehensive, sustainable healthcare reform that fulfills the objectives of lower costs, improved access, and improvements in quality of care and safety given this mentality.
We need a cleanup on reform aisle 2009. There is Jell-O all over the place.
© 2020 John Gregory Self