Thursday, January 15, 2009

What It Will Take for President-Elect Obama to Accomplish Health Care Reform

President-elect Obama has listed entitlement reform as a major goal for his incoming administration.

Just this week he said, “The big problem is Medicare, which is unsustainable. We can’t solve Medicare in isolation from the broader problems of the health care system.”

I doubt anyone would disagree with the President-elect on that score.

Fixing the entire U.S. health care system cannot be done in isolation from the Medicare challenge.

At the core of the Medicare challenge, and the challenge for the rest of our health care system for that matter, are what services we pay for and how much we pay for them. Medicare policy commonly drives private payment policy. Private fee schedules, for example, are often a factor of the Medicare system’s payments.

The President-elect’s incoming budget director, Peter Orszag, recently released a very important report while at his old job—head of the Congressional Budget Office. It itemized the fiscal options for health care reform. I am pretty sure the President-elect had this report in mind when he commented about the unsustainability of Medicare and the linkage between Medicare and the private health care system.

That CBO report made it clear that the relatively easy lifting in Medicare, or broader health care, reform—things like better health information technology, wellness, prevention, outcomes research, and the like—will have only a modest and insufficient impact on health care costs to really get the job done.

The real heavy lifting will be in actually changing provider behaviors by finally eliminating wasteful procedures and technology, addressing payment reform head-on, and finally cracking the high administrative costs we carry in the U.S. health care system.

The new President talked this week about the importance of at last facing up to the real health care problems, “This by the way, is where there are going to be very difficult choices and issues of sacrifice and responsibility and duty.”

President-elect Obama could not be more right.

In my mind the only way he can accomplish health care reform is if he and his administration spend the time to bring the American people up to speed on just what those sacrifices look like in order to build the enormous bipartisan political capital needed to force the stakeholders out of their “me” mode and ready to accept the “difficult choices and issues of sacrifice and responsibility and duty.”

What drives me crazy are all the stories I read about how health care reform will be different this time because the big stakeholders are ready and there is consensus for what reform will look like.


I get the sense our new President understands just how hard this will be.

Today, President-elect Obama has nowhere near the political capital he will need to get this gargantuan health care policy problem across the line.

I hope he takes the time to build the political capital that he can only have after he has brought the American people onside. To do that he will have to bring health care reform to the forefront of the public discourse over a period of many, many, months.

When the “difficult choices and issues of sacrifice” that have to be made look to us all as inevitable, then, and only then, will he will finally have the political capital he will need to make his health care move.

I believe we have a leader who is bringing good will to his health care reform efforts. I hope he is successful.
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