The air is turning crisp while the days have been getting shorter. The fall season is already upon us and it's again time to root with high hopes for the home team. To more seasoned fans, however, a moderate amount of skepticism abounds.
Isn't it around this time every two or four years when our team starts to falter and take a nosedive in the polls? When flashier, well-funded competitors make the big push toward success in the post-season? No, we're not referring to the disappointments of the Chicago Cubs or the Oregon Ducks. We're of course talking about Health Care Reform.
Election season in 2008, however, somehow feels different.
Surprisingly, health care reform remains a top issue among voters today. In the most recent Gallup poll conducted in September of this year, health care was tied for second as the most pressing issue facing the future president, behind the economy and tied with "the situation in Iraq" and "energy, including gas prices." And during the presidential debate Oct. 7, Sen. Barack Obama went so far as to name health care reform as the second among three domestic priorities.
For the first time in more than a decade, there is hope that health care reform will remain a top issue in the post-election season. But what is driving this surge in importance? And are there lessons to be learned from our past? What is the likely trajectory for reform in 2009 and which policy direction should our country take? A brief look at our past reveals a vast array of hazards and possibilities.
A History of Defeat
Over the last hundred years, a countless array of health care reform proposals have been introduced and defeated in the U.S. Notable wholesale efforts included former President Truman's attempt in 1945 to establish a national health insurance plan, former President Johnson's Medicare and Medicaid programs established in 1965 and former President Clinton's reform efforts in 1993.
The reality is that fundamental health care reform is truly difficult. The reasons for this are several. First, the "pain" of our current health care system is not always evident. For the 80% of us who are lucky enough to be reasonably healthy, we don't interact with the health care system enough to realize its pitfalls and defects. And that is often reflected in election-year polls. As recently as 2004, health care was eighth among voter concerns (behind moral/ethical values, jobs/economy, terrorism, the situation in Iraq, social issues and taxes).
Second, even if people perceive a problem with our current health care system, most people cannot agree on a solution. The financing and delivery of our system is so complex, fragmented and counterintuitive that even the most veteran policymakers cannot be confident as to how all parties may be affected by new legislation. More often than not, legislation has resulted in cost shifting and other unintended consequences that have sometimes resulted in worsening the situation.
Lastly, third-party insurance, which has become the fabric of health care financing in the U.S., has fostered the growth and entrenchment of large health care entities for whom almost any efforts at reform will result in their partial or complete disintermediation. Because of the complexity of the system and the strength of the political lobbies, any substantive reform is typically doomed at the start. As many have noted, the status quo is every party's second-best alternative.
The Opportunities of Today
Despite the failures of the past, the opportunities for reform in 2009 seem greater now than ever. Most importantly, the desire for change, as reflected in the polls, is persistently strong.
As costs have continued to escalate while coverage has become spottier, a greater percentage of the population is starting to feel the pain of our current health care system, particularly in the context of a downturn in the economy. Most notably, businesses are increasingly feeling the pain of rising health insurance premiums and looking for some measure of cost control.
Second, the political landscape appears to be favoring legislative and executive leadership from the same political party. Though far from a done deal, and not necessarily a good thing, history has shown that sweeping reform is more likely to occur when both branches are occupied by the same party. If dramatic changes are needed in health care policy, it's unlikely to be accomplished through bipartisan incrementalism.
Lastly, the tools and standards for innovation have changed dramatically over the last several years. As Internet technologies have begun to permeate society, the possibility for transformation in health care becomes more palpable -- whether in the form of electronic health records, personal health records or consumer communities. The possibilities for change and efficiency become much more tangible.
Post-Season Outlook
Despite the unique opportunities that appear ahead of us, however, it's hard to present a rosy picture for sweeping health care reform in 2009 or anytime in the next several years. History has shown that political will does not necessarily translate into political reform.
More importantly, after almost a year of debate, it is still unclear what the key health care reform issues are and how best to solve them. To date, most of the discussion has been focused on how to maximize coverage for the under- and uninsured through a variety of financing mechanisms. Meanwhile, very little has been discussed as to what will truly reduce the cost of our health care system.
Some have suggested that IT will reduce costs and improve the quality of care. Though plausible, it's not clear how a federally sponsored program would foster the results and efficiencies we'd expect to gain from the system.
The reality of the situation is that we need to stop expecting the "health care system" to reform itself. Or to hope that policymakers can come up with the right solution for us all. We need to stop rooting from the sidelines and instead get on the field of innovation ourselves.
Most of America's great innovations have come from the private sector (sometimes funded by government, but not directly from government). And if we are hoping for winning seasons in the future, it's about time we did our part to build and grow companies that fostered the change we're looking for. The team that is most likely to accomplish the greatest results is the one that you yourself lead, no matter what the polls say.
MORE ON THE WEB
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Gallup Polls
- "Obama, McCain Tout Health IT in Final Presidential Debate," iHealthBeat, 10/16