Sunday, November 23, 2008

An Adult Conversation About Health Care Reform

Zeke Emanuel and Shannon Brownlee have an op-ed in Sunday’s Washington Post that should be required reading for anyone interested in health care reform.

The title is, “5 Myths About Our Ailing Health Care System.”

They suggest the “5 Myths” are:
  1. America has the best health care in the world.
  2. Somebody else is paying for your health insurance.
  3. We would save a lot if we could cut the administrative waste of private insurance.
  4. Health-care reform is going to cost a bundle.
  5. Americans aren’t ready for a major overhaul of the health–care system.
At one level I can disagree with many of their points and at another I can agree with all of them—but they are right on all counts.

For example, as I have argued on this blog before, Americans are nowhere near ready enough for health care reform because most in the middleclass who vote have good health insurance paid for by their employer. As a result, voters don’t have a big reason for change in this regard—no matter the real costs of health care. But, as the authors point out, our people are in fact paying for their health care through lower wages and higher taxes.

What Emanuel and Brownlee are doing is having the kind of adult conversation with the public that our national leadership really needs to have in order to be able to build the necessary underlying consensus for health care change.

Without that kind of conversation, continuing with the same example, our people will never understand that the employer support for their health insurance costs they are enjoying is in fact illusionary. Until that, and so many of these other points are broadly understood, we will never have the consensus we will need for successful reform—getting it passed or doing it right.

Our health care access problems are symptoms of the real problems—uncontrolled costs and inadequate quality.

Today in Washington, most of the political discussion is heading toward a big expensive comprehensive Massachusetts-like package that really wouldn’t change anything, would probably make underlying costs worse, and would likely not even pass—falling of its own weight before the year is over. But the current effort does address many of the superficial political problems our health care system presents—particularly on access—while more often only giving cursory attention to the underlying cost and quality issues that are driving the access problem in the first place.

To build the kind of broad public consensus for the health care change we really need, it will be important to build a solid foundation that addresses the more politically problematic cost and quality issues as a priority at least equal to the access challenge.

To build that foundation, our leaders need to start addressing these more problematic challenges. They need to do that with facts, get beyond the simplistic myth-filled discussion we are used to that often drives the debate, and take the time to build the consensus required for any real reform.

We don’t have time? We are about to waste 2009 and have little or nothing to show for it at the rate we are going.

As the authors put it, "Now is not the time to think small, to cover a few million Americans and leave the bigger job of controlling costs and improving quality for another day."

Now if we could just figure out a way to get Zeke an audience with the new administration…

Earlier post: "Healthcare Guaranteed"--A Health Care "Solution" Offered Dr. Ezekiel Emanuel


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