I just got back from a brisk walk (after yesterday’s blog, I at least tried to exhibit some Personal Social Responsibility by getting some exercise!) by the Capitol, the White House, and the National Mall all lit up at night. What a stunning view! I really needed that dose of inspiration to lift me up beyond some of the ugly politics that goes on inside and around those beautiful buildings. If only we could be so lofty and grand in our daily endeavors as those magnificent monuments that bare witness to our higher and more noble abilities.
Okay, back down to earth, Eric.
There’s a lot of talk around town about The Talk. That being, of course, the imminent and eminent speech from the President tomorrow night about healthcare reform. I’m in a hopeful mood after my walk, so let me lay out some things I personally hope to hear:
1) That we’re “staying the course” to do real healthcare reform, now. We can’t defer this issue again to a future Administration. That doesn’t mean we can’t take more time to do reform right—we shouldn’t declare “Mission Accomplished” prematurely—but the President and Congress need to stay committed to moving our country forward with access for all, payment based on quality/value, care coordination, and cost savings.
2) That he has not given up on bipartisan compromise. He needs to coax some in Congress to act more like Ted Kennedy did—to reach across the aisle and make real compromise. This bill is too important to ignore Republican ideas, to squeak by with a Democratic majority, or even worse, to use an obscure loophole like reconciliation to close off filibuster and reduce the threshold of votes needed to pass.
3) That the commitment to cover everyone remains. It’s time to act and be like the economic world power that we are, which means giving every American access to quality healthcare. It is important for our nation morally, economically, and competitively. Almost everyone is for universal coverage (which, I should point out, is different than—and can be achieved without—a “public option” or a “single payor” system). So let’s “leave no patient behind” once this healthcare reform work is done.
4) That healthcare reform is bigger than deciding a “public option.” I am disappointed to see politicians playing chicken with something as important and complex as healthcare reform by reducing it to a fight over the public option. There is far more to get done than just insurance reform, and no matter “who pays,” we have to change how we pay and how we deliver care. Congress has chosen to make this issue the battleground, but they can just as well choose not to divide-and-conquer each other and our nation on this issue.
5) That government protection and market competition are not mutually exclusive. We seem to be headed towards an “either/or” false dichotomy: either the government runs and pays for all of healthcare or there is a free-market insurance system. I, for one, don’t want insurance companies to have free reign to kick me out or make my rates prohibitively expensive if I become seriously ill or have a pre-existing condition. After all, I pay for insurance for exactly those kinds of scary scenarios. There needs to be some reform, regulation, and government oversight of the industry. At the same time, I am not exactly encouraged by Medicare and other existing government-run healthcare programs as being the epitome of fast-paced, ever-improving, service-oriented institutions needed to deliver great care to the whole country. There needs to be a competitive insurance marketplace where private and government options compete on a level playing field. Let’s find a middle ground. (See #2…compromise…above.)
6) That there will be a focus on the tough problems: chronic disease and seniors. We can’t achieve meaningful cost savings without tackling better ways to prevent and treat chronic disease and finding ways to help seniors live longer and healthier from their own homes. The lion’s share of costs come from these areas. We need to admit that the age wave is upon us with a flood of chronic and age-related illnesses and injuries, so let’s focus on redefining long term care and chronic disease management for the 21st century.
7) That we’ll tackle moving 1/3rd of care from institutions to homes in ten years. There is no scenario in which we will come up with enough dollars or doctors or nurses to continue to see everyone in face-to-face visits in a clinic or hospital for every healthcare need. We can’t afford it today. We can’t afford it when the number of seniors doubles. We can’t afford it when we add 47 million uninsured to plans. Home based care has to become a part of our national strategy for reform, and “virtual visits” to the home through telehealth technologies need to become as normal in American life for many kinds of care needs as email has become. Use hospitals for what they are good for, but use homes for what they are good for, too.
That he’ll talk about the new responsibilities we’ll all need to take ownership of. School students aren’t the only ones who need a reminder to take personal responsibility in our society. All of us—as patients, providers, plans, politicians—are going to have to undergo some behavior change if we are to succeed with healthcare reform. This will take some personal sacrifice and some new roles and responsibilities for all of us. Culture change is hard and anxiety producing, but we need to be honest with people about what is expected of us going forward, from taxes to healthier behaviors to family caregiving.
9) That continuous innovation will be designed into our reform infrastructure. No one should believe we’re going to figure out how to fix our largest sector of the economy that impacts every single person in one session or even one lifetime. We need Medicare, HHS, and other government-run sectors to embrace innovation and innovation methods—and to drive continuous, iterative improvement of our delivery and payments systems. Healthcare reform needs to be an ongoing exercise, not a once-a-generation disruption.
10) That care coordination will still be a priority. Regardless of the flavor of the conversation you speak—“care coordination” or “medical home” or “accountable care organization” or “payment bundling” or “care teams”—we need to keep speaking about and enacting models of care that reward the coordination and collaboration of care across specialties and across peoples’ multiple healthcare conditions and issues.
Okay, enough digital ink spilled on this top 10 list. I’ll go to bed with this last thought: we need details. While I know there is only so much detail that can be offered in a televised speech to Congress, we need to see some follow-up documents with more details. The President can’t stop at high level principles and compelling personal interest stories. He has surrounded himself with some of the smartest minds on the planet about healthcare and innovation—it’s time to see what that brain trust has come up with to solve one of our society’s most pressing issues. And it’s time to take this conversation to the next level of detail and action.
Comments are welcome. please post to: http://blogs.intel.com/healthcare/
NOTE: ERIC DISHMAN’S ‘HOME BLOG’ PAGE HAS MOVED TO: blogs.intel.com/healthcare.