Nine Truths in US Health Reform

Washington, D.C.

When it comes to health reform, it is time for the American people to “agree to agree.”

In my first post on this blog, I mentioned that I don’t pick political sides in the endless debates on US health policy…and I don’t.  But as the impending election approaches, more and more political maneuvering has become focused on re-evaluating our recent health reforms.  Maybe we should shut down improvement incentives?  Or maybe even reverse the legislation?  The increasingly polarized arguments are driven nearly exclusively from philosophical perspectives — big government vs. small government, fiscally liberal vs. conservative, etc..  But health care improvements need not be as politically charged as many politicians would have our people believe.

Most industry leaders could agree (if reluctantly) on four points:

1.  Health care is severely broken — the entire ecosystem: providers, payers, pharma, government…all of it.  Dan Munro has a great Quora post on this topic; I’ve borrowed some of the charts he pulled together below.

Per Capita Health Care Spending

2.  Without coordinated action, health care will stay broken and bring havoc to our economy.  The problem has been getting worse, and prior to recent health reforms, there was no way the market was going to resolve these issues in a reasonable period of time (if ever).

3.  Existing health reform efforts are accomplishing something that had not been done before; namely, facilitating a more immediate patient-oriented transformation of health care while spurring the long-lagging adoption of information technology.  Whether you agree with the financing of it or not, the transformation is now underway.

4.  Existing reforms are neither perfect nor adequate.  Insurance reform and health information technology adoption were required first steps (e.g., forcing different incentives, collecting information from which we could eventually make better decisions).  But hard work awaits.

If we can agree on those points, we should be able to agree on one other point:

5.  Improvement delays — especially those driven by political philosophy instead of informed industry strategies — should be unacceptable.  We cannot let ideology obscure reality.  If we hinder the progress now underway, more people will suffer: medical costs will bankrupt more families, citizens will receive sub-optimal care, and health care costs will increasingly compromise our national economy.  These things are known.

Milliman Medical Index chart, care of Dan Munro

For any political party, delays in health reform should be seen as a dereliction of elected duty.

When a patient enters the emergency room after a traumatic accident, the first step is stabilizing the patient: the heart needs to be pumping, the lungs need to be breathing, and any bleeding must be stopped.  That’s what health reform today is doing — trying to get a new baseline of vital signs for industry health.  If a doctor came into the ER and started cutting stitches and removing IVs without knowing how to treat the patient , we would most certainly question his or her competence.  As a nation, we need to agree on a long-term national health strategy that will get our patient healthy before we cut off the care being delivered today.  Let’s not put our citizens at any greater risk of medical or financial suffering — lets “first do no harm” while we develop longer-term approaches that reflect national consensus.

In order to do this, the American people should exercise our obligations as citizens to ensure the long-term viability of our country:

6.  We must hold ourselves and our elected officials accountable for producing results, not prosecuting ideologies.  If you hold an elected office, health care is not just a policy issue — it is your problem to fix.  If you can’t show a very specific and better plan, it would be irresponsible to interrupt the progress underway.

7.  We must demand that people debate specific solutions, not philosophies.  Philosophies and ideologies almost never represent ideal solutions.

8.  We should seek compromises for our collective good.  If the only way to win is to create losers among our fellow countrymen, we will be weaker as a nation (note: the demand for financial losers within the health market has been one of the forces that created this crisis).

9.  We must accept the uncomfortable reality that no health reform solutions can be either effective or sustainable unless we do our part as individuals to improve our individual health.  Governments can and should tackle the big problems, but citizens must do their part: if we want the quality of life enjoyed by a healthy people, we must live healthy lives.

As the Bipartisan Policy Center has shown, health reform doesn’t have to be political.  It can be what our other great achievements as a nation have been: unique, creative, powerful.  And united.