Wednesday, August 20, 2008

"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.
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