With health reform, President Obama had a great opportunity to correct some rampant flaws in the healthcare system. But for several reasons, which I'll itemize, the reform process has become its own worst enemy. The election in Massachusetts is the latest sign that the reform process is running out of steam, although it's not over yet.
This didn't have to happen. When the process started, practically everyone in healthcare seemed to agree that serious reforms were needed. Healthcare consumes 16-17 percent of GNP. There is too much waste in the system and not enough coordination. Personally, I have been particularly bothered by insurance practices like denial of coverage based on preexisting conditions and the lack of portability of insurance policies across the market.
Many hospital leaders have been embracing reform, even though they have had some reservations about it. So why, after coming all this way, is reform in danger of imploding? Here are some of the factors.
1. In too much of a hurry. The Obama administration seemed to feel that if it didn’t shove health reform through now, it wouldn't happen. The administration was trying to create positive legislation, but there have been too many compromises and too many decisions behind closed doors.
2. Too complicated. The House and Senate bills each ran on about 1,000 pages and the details kept changing. First, first health reform was going to cover 47 million people, then it as going to cover 30 million. There was a lot of data and statistics thrown out and not much attention to what we're trying to resolve here. Things have gotten so complex that I think we have lost our way.
3. Unclear goals. For health reform to work, everyone needed to agree on the same goals, but it's unclear just what those goals were. Every good hospital administrator understands the importance of having a clear mission statement, but what is the mission statement for health reform? When you have gotten lost, a good mission statement is like a compass that can get you back on course, but we don't have one.
4. Too many special interests. Instead of agreeing on common goals on behalf of the American people, each constituency seemed to be pursuing its own special interests. The mantra was, "What's in it for my group?" This made the American people very cynical about health reform and what it could achieve.
5. No stakeholder dialog. Bill Clinton made a lot of mistakes with his health reforms, but I think he had it right when, very early in his presidency, he brought together all of the stakeholders in health reform and had them talk through the issues. I thought Barack Obama would do this too, but the dialog seems to have been between the administration and each interest group, like an axel to each spoke. That broke up the debate and made it difficult to arrive at a solution that includes everyone.
6. Public left in the dark. There was a lack of transparency. President Obama would have been well served if he had initiated a public debate on needed reforms, but this never really happened. The public was cut out to of the dialog. If the American people had been told the reasons why health reform needed to happen, I think they would have understood. But the administration seemed to feel this legislation was too complex for them to understand.
7. Leaves out the average American. I haven't heard much about how health reform would affect the average patient. The administration has mentioned some general things, along the lines of "people will have better care," but no one understands what that means.
8. Too focused on financing. In the health reform debate, there was a preoccupation with how are we going to finance this legislation. Reform would reduce Medicare by $500 billion, which makes Americans think "rationing" and they don't like it. They are beginning to think of health reform like they did of HMOs when managed care fell out of favor in the late 1990s.
I still think some sort of health reform bill will be put through, but it will be messy. The American people are now afraid of this thing. They seem to be turning on the reform bill and perhaps on President Obama.
Healthcare has undergone a lot of reform and it has always survived and, to a great degree, prospered. I think of DRGs, which were roundly hated when they ere implemented in the early 1980s but are now widely accepted by hospital executives. However, I don't know where we're headed now. I'm as mystified as the next person.
Chuck Lauer (chuckspeaking@aol.com) was publisher of Modern Healthcare for more than 25 years. He is now an author, public speaker and career coach who is in demand for his motivational messages to top companies nationwide.