"Chastened and More Sober, Harry and Louise Return"
Brian Klepper joins us again today on the subject of just how realistic health care reform will be in the coming year.
Chastened and More Sober, Harry and Louise Return
by Brian Klepper
Yesterday Ron Pollack of Families USA led a call with bloggers - unfortunately, I couldn't be on it - to discuss a new health care reform campaign sponsored by 5 prominent organizations: the American Cancer Society's Cancer Action Network (ASC CAN), the American Hospital Association (AHA), the Catholic Health Association (ACHA), Families USA and the National Federation of Independent Business (NFIB).
The goal of these collaborators is to get the next President and Congress to focus on meaningful health care solutions. Beyond that - and of course all those experienced with the policy-based reform process are aware of this - the motivations and objectives of the participating organizations diverge. To get an idea of the degree of their differences, look at the ASC CAN, Families USA and NFIB sites.
The first three groups are all provider organizations. Naturally, they're concerned that money is evaporating for their services, and they want to make sure they'll get paid for any services they provide.
Families USA is an idealistic consumer advocacy organization that believes the US should provide universal coverage because its the right thing to do. (They tend to pay less attention to the structural problems in health care that have created runaway cost.) While its an admirable perspective, it also willfully ignores the fact that Congress hasn't passed any major social-justice-based laws for more than 40 years, and that as long as special interests continue to be allowed to exchange financial contributions for influence over policy, it is unlikely we will return to policy in the common interest.
It's the fifth organization that's interesting and unexpected. The National Federation of Independent Business is the generally conservative association representating small business. Here they join with past adversaries, though NFIB's mantras - affordable, stable coverage with choice guided by knowledge of price and performance - is at odds with some of their current pals.
The ad itself has a winning earnestness. Go here to see the new one, and here to see the one from the Clinton period. Like the country, now chastened and more sober after its indulgence in patriotic zeal during the early Bush years, Harry and Louise, older and wiser, aren't so cavalier about Congress making decisions without their input. The health care crisis is all around and they need help. The punchline has Louise, with heartfelt concern (against a plaintive musical score), saying, "Whoever the next President is, health care should be at the top of his agenda, bringing everyone to the table, and make it happen!"
It seems so straightforward! When I was working day-to-day on national health care reform people would call to tell me what needs to happen. As it turns out, knowing what needs to be done isn't the hard part. Most everyone inside and outside of health care who's thought about it even a little knows most of those answers.
No the hard part is making it happen within a policy framework that's controlled by money and power. Displacing the status quo isn't easy at all. And as it turns out, its pretty clear that, while each of the organizations at this table dearly want reform, they, like all of us, want it on THEIR terms.
I attended and blogged Family USA's big meeting some months ago in DC. The had a range of terrific speakers, but the politicians among them - Ms. Pelosi included - pretty much told them what they wanted to hear, that health care reform can happen if people like them just stand up for it. Feeling empowered, the audience LOVED that message. It didn't particularly matter that it wasn 't true.
The truth is that unless the nation's most influential power brokers mobilize to make changes in policy, it's not likely to happen. Consumers certainly aren't galvanized around any specific health care reform agenda or project that I'm aware of, so they don't have a significant power base on this issue. The good news is that a range of non-health care Fortune organizations ARE working, quietly but forcefully, on the problem, through the Patient Centered Primary Care Collaborative and other efforts.
More on that soon.
6 comments:
Outstanding post, Bob. Pessimistic, but true.
One of my co-workers used to work at NFIB, and she says NFIB's mission is to become the biggest seller of health insurance plans to small business. If they are involved in this coalition, then they must see it as a means to that end.
I don't think this is any proprietary secret, either. You can probably Google around a little and read one of NFIB's top executives stating that they want to be part of the delivery channel.
Brian--
What's remarkable is how you and I often seem to be writing on the same topic at exactly the same time.
And, as usual there is a weird overlap in what we are saying as well as notable disagreement.
This morning, I just posted a piece about "Health Care Reform,
Interest Groups and the "Collective Good." (See www.healthbeatblog.org)
I was responding to Nicholas Lemann's piece in The New Yorker
where he suggests that there is no such thing as "the collective good" or "the common good" and that policy can only emerge from a battle among interest groups, each fighting to protect its own turf.
I suggested that when it comes to health care reform, there is a collective or common good: the interests of the patient. Someday, we will all be patients looking for high quality, affordable care. And none of us knows whether we will be one of patients who faces a $3 million bill that only a fraction of the population can afford. This is why we must pool our unknown risks in a program founded on a belief in the "collective good."
I also argue that we should not invite every interest group to the table. Some interests groups have too much power (thanks to campaign contributions.)
If we recognize the true goal of health care reform : "the collective or public good" then we should realize that, if given a seat at the table,lobbyists representing Pharma, Device-Makers, the AHA etc. will trump the public interest every time.
We haven't passed meaningful social legislation in decades because those interest groups have grown stronger--and as they compete with each other, they often create gridlock.
Most Americans have wanted universal health care since the late 1940s. The reason we don't have it is because we have accepted the notion that public policy is something that can arise only through "deal-making" among competing self-interested parties.
We need collaboration--not competition--among groups that have just one goal: higher-quality, sustainable health care for everyone. That means containing costs. For-profit businesses in the health care industry want to see health care spending grow, so that their earnings can grow.
If other (non-health care) businesses are primarily
interested in public health--i.e. the health of the nation--they may bring something useful to the discussion. But we have to be wary.
For-profit corporations have a hard time looking beyond their own monetary interests to the moral interest--the policy that is simply right on the merits.
By contrast, I think that most (though not all) physicians and public health experts do put the patients' intersts first. And this is why I would like to see them unite with patients--and help educate patients-- so that more of us understand the goal: higher quality, egalitarian and affordable health care for all. Everyone needs to realize that higher quality and lower costs go hand in hand.
Maggie,
Make no mistake. You and I both WANT the same things in HC. I'm just a little more jaundiced than you, and don't think consumers are likely to overwhelm the grip that special interests have over our legislative processes. America government has forsaken the common interest in favor of the special interest.
But see this post by me - http://www.thedoctorweighsin.com/journal/2007/7/27/dont-invite-anyone-from-health-care.html - that describes a meeting of the Northern Nevada Health Care Coalition that Jerry Reeves MD and I facilitated a couple years ago, where we advised the Coalition to hold a big meeting, tell all the HC folks that they couldn't come but that we were going to talk about them. That brought ALL the employers in the community to the table. And, in an hour and 15 minutes flat, they decided to develop a collaborative claims data base that they could mine to identify problems and opportunities and then address them. That process is up and running now.
You and I fundamentally agree on far more than we disagree on. And one important principle is this:
The deck is stacked, and this is a battle for how the nation will work. We have no obligation to let the villains - those who have repeatedly demonstrated that they have no true stake in the common interest - in on the planning. The real goal is to develop enough heft to force their cooperation, without allowing them to dictate input that distorts the result.
Hope this is helpful.
It's certainly true that entrenched interests stand in the way of meaningful reforms. Although I tend to be somewhat cynical about the possibility of real change, I still believe that strong leadership can help to break up the entrenched interests and will be essential for health reform.
But who are these leaders? I'm not sure I see them in the current political landscape . . .
I have a question for the single payer proponets. Taking into consideration many insurance carriers are non-profit, and agents that sell group health bringing competition to the market make on average only 5% commission, and after single payer squeezes out what other savings are possible, then adding back in the inefficiencies of bureaucracies. Will it be beneficial for the people to live under the conditions a single payer plan must implement to prevent the kind of increases we have seen in the past?
Brian-At the end of the day it's a question of who are the power brokers who can enact meaningful policy change. Sadly, the special interests benefit from the silo mentality...each with the ability to shoot down meaninful reform and thus each serves as a cul-de-sac on the road to progress.
If for example the Pres. of a State Medical or Hospital Association were to propose/agree to a meaningful reform proporsal...it is distinctly possible their constituency might rebel and oops. that Pres of the association may no longer be at the table for the next session.
One wants to be hopeful that the stars are aligned but it may be practical incrementalism rather than wholesale policy reform that wins out in the short term.
Significant political leadership is necessary to implement meaningful reform...time will tell.
Jonathan Fuchs
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