By Evan Falchuk
At last week’s NBGH conference, I am told Senator Max Baucus made an interesting observation. He said that America is not Germany or the UK or Canada, and so whatever kind of reform we create here must be “uniquely American.” It’s an obvious point, but it highlights something important:
What does it mean to have a uniquely “American” healthcare system, and uniquely “American” healthcare reform?
Americans are enormously individualistic and our attitudes about healthcare reflect that. We want healthcare to be more accessible, but we recoil at ideas of massive new spending or increased government involvement in our healthcare decisions. We think our system is uncoordinated, expensive and in need of reform, but that our own coverage is just fine, thank you. Americans are also tremendously creative, and when faced with a problem try to tackle it with an entrepreneurial zeal. Indeed, the CBO recently summarized more than 100 reform proposals, and the President’s (awkwardly-named) Forum on Healthcare Reform brought together dozens of leaders and the work of thousands of reform advocates.
Americans are also very impatient – when we see a problem we want to fix it now. Even as the federal government sorts out reform ideas, states are implementing their own healthcare reform programs. Massachusetts is already in a new, second wave of reform to try to deal with the costs of its 2006 reforms. In Utah, the governor signed into law last week a bill that would give employees the option to take the employer’s contribution to their health insurance coverage and buy their own coverage from a state-run web-site. Overall, at least 17 states are considering or have adopted some sort of reform program tied to creating universal coverage, with numerous other reforms in the works elsewhere. There can be little doubt that these diverse and continuing efforts across the country will complicate attempts at a unified, national approach to reform.
At the federal level, the government is going to have to figure out a way to balance the burst of creativity shown across the country with the political pressure to pass federal reform. Maybe this is what Senator Baucus means by a “uniquely American” approach to reform.
The problem is, once we give them the go-ahead for “reform” the government will just bulldoze everything you’ve spoken about. All the concerns about quality and choice and individualization will be turned over into the soil along with the physicians.
Right now, this administration is just seeking a hole, a crack, to validate via its “mandate” which will then be used to squeeze through that first piece of top-down legislation. At that point the game will be over.
The reason that the language is so nebulous (health care reform — means nothing) and the proof of crisis is so tendentious (longevity data / infant death rates, etc)is precisely because they want to keep us chasing figments long enough the hammer a law through. And they will. Unless doctors really get tough — which I don’t see happening.
That’s why these issues cannot be reasonably discussed with them
You make a fair point, Dr. T.
But I don’t think it’s right that the problem of unclear definitions is either intentional or malicious. It’s reflective of the fragmentation of our health care system, and the many conflicting interests pulling it in different directions.
This lack of consensus, along with the many state initiatives, are I think the biggest barriers to something big and comprehensive at the federal level.
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