By Evan Falchuk
Everything is McAllen, Texas.
It’s all part of our “uniquely American” approach to many issues: oversimplify the problem, so we can solve it. Ideally, on an artificially short time line.
In the case of health care reform, let’s say we get ‘er done by August 1.
When we talk about health care reform, we are really talking about dozens of different issues. Is health care reform about covering the uninsured, or about cutting costs for employers? It is about having a publicly-funded health plan, or changing reimbursements to doctors? Is it about longer life expectancies or creating insurance cooperatives? Is it about caps on medical malpractice awards, or comparative effectiveness? Is it about healthier lifestyles, or cutting the cost of prescription drugs? Is it about cutting administrative waste, or incentives for more people to go to medical school? Is it about implementing new health care IT, or preventing insurers from making excessive profits?
It’s about all of these things, and more. And that’s the problem, if you’re an ambitious reformer. There is no simple way to get all of these things under one roof.
Well, until Atul Gawande introduced us to McAllen.
The President quickly made Dr. Gawande’s article on McAllen required reading at the White House, telling Senators this is the problem we are trying to solve. His point man on health care, Peter Orszag, has been blogging about it repeatedly. Members of Congress and the press have taken to talking about McAllen as the center of the health care debate. Even doctors from McAllen are calling on the President to come and see for himself.
Others are using it, too. Paul Krugman, in his blog, took on Harvard economist Greg Mankiw for saying that some comparisons of the US and foreign health care systems may be flawed as a premise for U.S. reform. In response Krugman said “read Atul Gawande!” I saw this, too, when I questioned Steven Pearlstein about why he had such a problem with doctors. His only response was “Maybe you should talk to Atul.”
The problems of McAllen make easy talking points. But they are also a convenient way of avoiding dealing with the enormous complexity of the health care system. There are nearly 650,000 doctors in America, millions of patients, thousands of hospitals, tens of thousands of insurance and pharmaceutical companies, hundreds of thousands of employers who provide health benefits, and thousands of other charities, academics, consultants, government agencies and others who have strongly held views about our system. Too often, their voices are not being heard in all the loud talking about McAllen.
And so, if reforming our health care system is, as the President says, a “moral imperative,” why can’t we have a process that treats reform that way? Why the rush to pass reforms that have to be sold under the premise of solving the problems of McAllen?
The President and the Congress are perfectly capable of putting together a respected commission of experts to study health care, in depth, and then return with serious, comprehensive recommendations that Congress and the President can work to enact. Polls show great public support for the idea of reform, but mixed understanding on what reform means. As we see from the evaporating support for reform in Congress, this gap is a serious problem.
We need effective health care reform in America. McAllen isn’t enough to close the deal.
[...] is saying we need to learn more. We need to understand how by oversimplifying these problems we may only make them [...]
[...] our rush to pass some kind of reform in the next three weeks, we fail to answer far too many important [...]
[...] New York Times, searching for a poster child for this problem, uncovered other, more interesting [...]
Evan:
The genius of the ‘Mayo v. McAllen’ frame is it narrows the complex series of choices (i.e., distractions) we face by putting the question of culture and provider organizational models in the center of the conversation.
As you correctly point out, it can not be about being all things to all people, given the definitional range of what different interest groups would insert to complete the following sentence health reform = ______________.
Provider culture and resulting organizational models is one of, if not the, principal driver to successfully reform our current dysfunctional health care system.
[...] We talked about the proper role of government, the comparative worth of systems in other countries, the responsibility of people to take care of their own health, end-of-life care, over-treatment, the uninsured, access to care, comparative effectiveness, and our own expectations of what the system should do for all of us. There was no consensus among this group of 30 business leaders as to these subjects and what we should do about them, other than that they are important topics that we need to address. I suspect this is true outside of this group, too. Indeed, the huge collection of issues that fall under the category of health care reform is something I’ve pointed out before. [...]
[...] We talked about the proper role of government, the comparative worth of systems in other countries, the responsibility of people to take care of their own health, end-of-life care, over-treatment, the uninsured, access to care, comparative effectiveness, and our own expectations of what the system should do for all of us. There was no consensus among this group of 30 business leaders as to these subjects and what we should do about them, other than that they are important topics that we need to address. I suspect this is true outside of this group, too. Indeed, the huge collection of issues that fall under the category of health care reform is something I’ve pointed out before. [...]
[...] I’ve noted before, when we talk about reform, we are really talking about dozens of different issues. Is reform about [...]
[...] As of Friday, there had been 564 amendments proposed to the Baucus plan. So this shouldn’t take long. Senator McCaskill thinks it won’t be until Christmas. It’s hard to believe a lot of people thought this could be done by August 1. [...]
[...] To think anyone thought it was possible to deal with all of this before August 1. [...]
For health care reform information that is diverse and unique you might want to check out: http://www.ourblook.com/component/option,com_se...
There are interviews and dialogues with 26 different medical professionals and health care professionals alike who offer diverse perspectives regarding the health care debate.
Until now, health care is still debated with nothing clear to expect. How's this one?
That's the great article! I just pass 'n read it, two thumbs up!
[...] the problem with health care in America is we keep getting lured into assumptions that money is the right metric to measure the quality of medical care. How much [...]
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I wonder what's the latest after the implementation of the much debated health care.
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