PDF “I am not the first President to take up this cause, but I am determined to be the last.”
I was impressed and moved by President Obama’s speech. But I do hope the president has a very narrow notion of “cause”.
In this situation “The Cause” should be viewed like D-Day – not the end of World War II but a very critical turning point. Like D-Day, there is an extremely long build up. Like D- Day both sides brace for battle. Like D-Day both sides understand the consequence of failure.
And also like D-Day, it will be the beginning of a very long campaign to delivery quality health care at an “affordable” price. Like D-Day, there will be set backs along the way. Like D-Day, some of the best laid plans will fail. And like D-Day, we will need to improvise as we push forward.
Unlike D-Day, the goal of health reform will always be in front of us.
Health care reform is not a once and done event. It is an iterative process.
Rome was not built in a day. The Model T did not come with four-wheel anti-lock breaks.
Germany as an example
When Germany under Bismark passed its landmark Krankenversicherungsgesetz (Health Insurance Law) in 1883 it provided coverage for 13% of the population. Various reforms every few years over the last 125 years have expanded that percentage. With its latest effort in 2007, the final 0.2% of the population without insurance will be required to obtain coverage. In 2009, all German citizens residing in Germany will be required to have health insurance.
It ought not take the United States that long.
And covering 100% of the population is not the only challenge here or elsewhere around the globe.
The wise owls offer insight
Just this week, the Robert Woods Johnson Foundation, the premier health policy organization, aired a number of perspectives on the challenges that will still lay in front of us over the next decades.
Mike Chernew, a professor and economist on health policy at the Harvard Medical School, writes offers some cautionary advice on cost containment – a key objective of the Obama reform effort. Use a scalpel, not a meat ax he advises and focus efforts on those that not only lower total costs but lower the rate of growth. And most important, assure that cost containment efforts will achieve the ultimate goal of improved health.
Peter Lee, executive director for national policy of the Pacific Business Group on Health, describes the importance of federal regulatory efforts to reform provider reimbursement and of public data disclosure efforts.
He raises the question in my mind whether a new public option would create a competing regulatory thrust or whether it would follow the lead of existing CMS regulatory efforts.
Elizabeth McGlynn, associate director at RAND Health, asserts the need to focus on doctor and patient compliance with established treatment and prevention protocols. Some quibble over the finding that only 55% of patients receive recommended care, but offer only no constructive suggestions to improve the outcomes of care.
Jonathan Skinner, Elliott Fisher, and Jonathan Sutherland of the Dartmouth Atlas Project at the Dartmouth Institute for Health Policy and Clinical Practice at Dartmouth College write offer insights about opportunities to pay for health care reform by reducing unnecessary spending.
They describe the reverse “Lake Wobegon” affect. Everyone wants to believe that their patients cost more because they are sicker than average. To achieve attainable savings, we have to move past the denial phase.
Lastly, Risa Lavizzo-Mourey, President and CEO of the Robert Wood Johnson Foundation, reacts to President Obama’s speech on health care reform. As a leader of the leading health policy group, she doesn’t deny her interest and role in the outcome of this debate.
“Last night’s speech reminded me of how badly we need this, this thing we call health reform.”
None of the authors address the challenges on the patient delivery side. The current proposals are important steps, but experience will be the test to whether consumers access to care will be seamless and affordable. It will also be the most important political judgement.
So we need to get this law passed. We need to take this important beachhead.
We need to put this most important battle behind us. But the long term struggle to achieve access, contain costs, and improve health delivery will just be beginning.
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