Blog > Category: Health Care
The politicians chatter Sunday night during the historic House vote on access to health insurance gave the impression that reform was done. Speaker Pelosi called it an extension of the Declaration of Independence, declaring, “health care is a right,” not a responsibility. Republican Boehner all but claimed it marked the end of free enterprise.
Wrong on all counts.
Passing this bill is a momentous step in granting health case insurance to 32 million Americans who lack access, something we can finally take pride in. But it certainly doesn’t end the urgent need for health care reform. Rather, this is the end of the beginning. Now the hard work must begin in earnest.
The bill addresses only one of four essential elements of health care. Left unaddressed are cost, quality and lifestyles. Unless we focus on all four, we will continue to have a dysfunctional system with unaffordable costs.
The bill does virtually nothing to constrain health care costs. It is “paid for” with tax increases that take effect this year and projected cuts in Medicare reimbursement, while delaying most benefits until 2014. If we don’t get health care costs under control before then, the CBO projected deficit reductions will turn into a trillion dollar increase the following decade.
Even the current round of Medicare cuts – over 20% for many physicians and hospitals – is unsustainable, as politicians plan to reverse them retroactively. If they don’t, many physicians and hospitals will refuse to take Medicare patients, just as the Baby Boomers enter the Medicare system. Last month Mayo Clinic in Scottsdale announced it could not afford to accept Medicare patients. Longer term, this could push the U.S. toward the British system of splitting into private and public systems.
Nor does this bill constrain insurance premiums. Wellpoint’s 38 percent rate hikes in California are going into effect, in spite of jawboning by HHS Secretary Kathryn Sebelius. Expect other insurers to follow. Can you think of any other product or service that could pull off price increases of this magnitude?
To bring health care costs under control and sustain access for all Americans, three things are urgently needed:
- Realigning incentives for individuals and health care professionals
- Improving quality of medicine
- Taking responsibility for healthy lifestyles
Incentives. The incentives in the current system are perverse. There are no rewards for people who stay well, and no penalties for leading unhealthy lifestyles or overusing the system. Nor are there incentives for doctors and hospitals to keep people healthy and to prevent disease. Studies have shown that those who do so find themselves losing income.
As a result, primary care physicians are forced to pack more office visits into already crowded schedules, while spending less time with each patient. Specialists are incentivized to do more procedures, even when lower cost alternatives are available. Hospitals are forced to conduct more tests and get people out of the hospital before they are ready.
We need to realign these incentives by rewarding people for healthy lifestyles and taking more cost-effective approaches to their health. Hospitals and physicians should be rewarded for keeping people well, by paying for outcomes and managing groups of patients with similar disease states, as well as for prevention and wellness.
Quality. Experts like Donald Berwick, MD of Institute for Health Improvement and Charles Denham, MD of Texas Medical Institute of Technology have identified ten quality issues whose correction could save tens of billions each. Managing chronic disease, which accounts for 75 percent of health care costs, in a systematic manner instead of as a series of acute events, could improve outcomes and quality of life for millions of people, while dramatically lowering the cost of care. Yet there is no national push to get either of these things done.
Lifestyles. It is estimated that lifestyle issues like unhealthy diets, smoking, alcohol, lack of physical exercise, and unmanaged stress account for more than half of all health care costs. Addressing these issues requires a national movement for wellness and prevention, modeled after the highly successful anti-smoking campaign, something virtually ignored in the current legislation. To motivate people to take responsibility for their health and live healthy lives, there also must be rewards for those who do and penalties for those who don’t. Many successful ideas have been demonstrated locally through consumer-driven health plans and the integrated health movement. Now those must be taken to scale nationally.
This is a complex set of priorities to realize in an already-stressed system. It is too complex to leave in the hands of politicians who lack deep knowledge of health care and are swayed by lobbyists. For these reasons it is likely that solutions will be demonstrated in local communities and then taken to scale nationally. This is a long, arduous process. But unless we being immediately, the U.S. health care system will make our country less competitive and less healthy.
Now is the time for health care leaders locally and nationally to step up to these challenges and to lead the movement of the U.S. to healthy lifestyles and an effective health care system. Let’s get on with the hard work.
On Tuesday night I appeared CNBC's "Executive Vision" series with a panel consisting of Dr. Bill Frist, David Snow, Gerard Kleisterlee, Sir William Castell, Jeffrey Kindler, Myrtle Potter to discuss the current health care industry landscape.
It was a quick-hitting discussion touching on everything from client-patient relationships, to corporate accountability, to the need for forthright internal and external communication (which we all agreed is necessity for effective management in a health care crisis).
In the end, I concluded that in health care, a company must retain and project core value of trust, integrity, transparency, and openess to be a successful organization. But I think it was my fellow panelist, Dr. Frist, who made one of the most compelling and pithy points of the night: "Leadership is built around healing, and healing is built around value... if you build value, you are a healer."
Take a look at the video links below for the entirety of the discussion. And as always, please let me know your thoughts.
"Blueprint for Breakthrough Leadership" Part 1
"Blueprint for Breakthrough Leadership" Part 2
"Blueprint for Breakthrough Leadership" Part 3
"Blueprint for Breakthrough Leadership" Part 4
"Blueprint for Breakthrough Leadership" Part 5
7:56pm EST - @Bill_George: “#health – waiting for pres. obama’s speech: anticipate he’ll take middle ground on insurance & propose ins exchange instead of public option”
Last night I was confident of several things. First, my Twitter addiction had officially taken hold, and I would fuel it by tweeting my way through the President’s Address to Congress (“Hey, that would make great material for a blog post”…). Second, this speech would define the remainder of the health care reform debate. The President would either steer Congress further into the quagmire or redirect them towards drier, middle ground.
7:59pm - “#soccer – miserable first half for u.s. – donovan had great chance at the end – must do much better in 2nd half”
Lastly the President, and certainly the cast of characters on the House floor, would likely be far more entertaining than the first half of the US v. Trinidad & Tobago soccer game. But I digress.
I switched channels just as the President’s cabinet weaved across the floor. And as the President himself assumed the podium, I wondered: would this speech be a high-flying rhetorical display, or a practical treatise? Would the President go on the attack or play defense? How deep in the weeds would he get on policy? Would he be the Democratic politician, or the bipartisan leader?
Most importantly, how would Congress and America respond? One way to answer at least that last question would be to do just that: respond. So, I did. The following is an array of my Twitter conversations across the duration of the Address, intermingled with a few respective clarifications. What were the in-the-moment reactions to the President’s speech? As they say in the Tweetdom, “follow me”:
8:04pm – “#hcr Pres. Obama must retake control of hcr debate tonite. not about dems and repubs but what’s in it for us and how will he pay for plan?”
And the President was off: “When I spoke here last winter, this nation was facing the worst economic crisis since the Great Depression. We were losing an average of 700,000 jobs per month. Credit was frozen. And our financial system was on the verge of collapse.”
8:10pm – “#health – interesting that Pres started with jobs crisis – at least he is facing that reality but no solutions offered – on to health care”
At the time I was intrigued, but it made perfect sense for the President to set the proper scene: America’s struggling but slowly-recovering economy. This placed the issue in proper context. Cost-effective, long-term health care reform is one necessary component of regaining a strong financial footing and putting Americans back to work.
8:19pm –“#hcr – Pres doing job of making the case for insurance reform – We shouldn’t lose coverage with pre-existing conditions or loss of jobs.”
8:26pm – “#health – insurance exchange makes sense -self-funded? run by government? In lieu of public option? Mandatory coverage good but a tough sell”
I was very impressed with President’s cohesiveness and efficiency in these opening lines. And he was very shrewd to highlight issues of universal agreement alongside issues of universal debate. Compelling recognition of shared interest, this was an important and recurring strategy in the speech, as well as an important step in making the debate respectful as Congress moving forward.
8:33pm – “#health – good move to take on bogus claims by Palin, et al and insurance companies denying coverage”
I had hoped the President would take “death-panels” head-on, and he did so with a confidence and above-the-fray dignity that every President should project in such circumstances.
8:40pm – “· #health – looks like public option is back. He is doing a good job (finally) of making the case. promising savings, but where’s the beef?”
I concede that it’s difficult to interweave important policy nuances into an hour long speech, but the details are what matter right now. At this point, I was still waiting. And so were the Republicans, as they waved copies of a GOP health care bill.
8:48pm – “#health – are medicare savings he’s promising real, or just more reimbursement cuts? Good move to take on malpractice costs and tort reform.
Time, and the Congressional Budget Office, will tell if the savings are legitimate. However, I was pleased with the President’s stance on malpractice and torts. He scored points with independents and conservative Democrats with that one.
9:07pm – “#soccer – US beats T&T 1-0. Great win on the road. Much better play in 2nd half. Good for Ricky Clark. On to World Cup – Let’s get top seed.”
I just had to check the score. And to my pleasant surprise, the US came a winner tonight. Switching back to the speech as the applause boomed and the President stepped down, I pondered: was Obama’s speech a winner too?
9:09pm – “#health – an excellent speech by Obama. Finally, he is back to being a leader and taking control of debate – now the hard work begins.”
Just eight months into his term, Barack Obama is facing a severe crisis that will define his leadership as president. The immediate challenge is health care reform, but the deeper issue is whether Obama the Leader or Obama the Politician will dominate.
Like the Roman god Janus, with two heads facing in opposite directions, Obama the Politician pulls against Obama the Leader. This identity crisis is eroding the President’s political capital, hampering his chances for legislative success on health care, and alienating recession-stricken Americans.
We have always known there were two Obamas: one, the idealistic and compassionate community organizer whose service changed lives; the other, the skilled operative who emerged from the political wars of Chicago’s south side. During the long, brutal presidential campaign, Obama did a brilliant job of integrating these two facets of his persona. Many who supported him hoped and trusted that once elected to the nation’s highest office, Obama the Leader would retain his passionate commitment to certain ideals over and above political considerations. Since January, however, politics has seemed to dominate many of his decisions, with health care being the most recent example.
Rather than provide the leadership he promised on this crisis by presenting a comprehensive, integrated health care policy to the American people, Obama is instead playing politics by ceding leadership to Congress. In leaving the details of the reform bill to Congress, he has effectively abdicated, removing himself from substantive Capitol Hill discussions. Congress, in turn, has focused on only one aspect of this complex problem: health insurance reform that will provide guaranteed access. The other essential aspects of health care — cost, quality, and consumer focus on wellness and prevention — are being virtually ignored. All three must be addressed in an integrated fashion before the health care crisis can truly be resolved.
This will require real sacrifices and concessions from everyone, and a politicized executive cannot make that happen. What’s needed here is realistic and, above all, forthright leadership. How can the President shed political pretense and become the same galvanizing leader on health care that he was during the 2008 campaign? How can Obama the Leader predominate over Obama the Politician and take full ownership of this process?
As leader of this all-important reform effort, he must immediately face the reality that the debate is going in the wrong direction, acknowledge the mistakes he made in abdicating and ceding leadership to Congress, and put the legislation on hold until early 2010. In my recent book, 7 Lessons for Leading in Crisis, this is Lesson #1: Face reality, starting with yourself.
Then he needs to go on offense. Obama should introduce an integrated plan that focuses first on wellness and prevention, develops detailed programs to incentivize quality outcomes and reduce costs, and offers affordable access. Most important, he must take his case to the American people and convince us that this plan is the only way to resolve the health care crisis for the long term.
During the campaign President Obama delivered a remarkable, uplifting speech on race in Philadelphia that elevated our level of national discourse. As president, he has demonstrated strong leadership in the Middle East peace process, and he has guided us away from financial collapse. Here is a man who is capable of authentic leadership.
Now, on health care, the United States needs Obama the Leader to step up again.
On August 7th Alaska Governor Sarah Palin warned that Congress and the White House will create bureaucratic health rationing panels – aka “death panels” – to decide whether America’s sick, aged, or disabled are “worthy of healthcare.” In other words, Palin predicts the government will decide if you live or die, should pending legislation become law.
In the same breath that she mentions death panels, Palin asserts that “[h]uman rights and human dignity must be at the center of any health care discussion.” I wholeheartedly agree. “Rights” and “dignity” are central to the health care discussions we have with our doctors, particularly end-of-life consultations about our future care.
A wide range of media have delivered over forty reports refuting this warped and unfounded claim but shockingly, it is still believed by many, much like last year’s charges that President Obama is a Muslim. Conservative pundits and fringe elements are using it as a call to arms to oppose reform.
Spare us the pain, and examine the facts.
Proposed legislation provides Medicare funding for voluntary end-of-life counseling, also known as advanced care planning consultation. This permits American citizens to visit their doctor once every 5 years to discuss issues like hospice care, health proxies, living wills, and appropriate future pain medications. There are no provisions for bureaucratic health boards, no mentions of care rationing, and no allusions to anything resembling a “death panel.”
Despite all this evidence, arguments to the contrary pervade the blogosphere. The misinformation just won’t stop. Those who hype the “death panel” argument continue to distract attention away from an already confusing debate on healthcare. We need to focus on the framework and details of an integrative, preventative healthcare reform approach, and not get lost in the mire of deficient, inflammatory rhetoric.
Regardless of how irrational their basis, “death panelists” are having a very real impact on healthcare reform. The New York Times reported on August 14th that the Senate will likely drop end-of-life care provisions because they “could be misinterpreted and implemented incorrectly.” Furthermore, USA Today reported on August 18th that while end-of-life counseling “started out as a rare example of congressional bipartisanship,” the measure has effectively zero chance of passing. Not only has Congress been forced to ignore one potential building block for consensus, but many American citizens may be forced to enter a very trying period of life with little to no guidance from their personal physicians.
Framing end-of-life counseling as some form of forced euthanasia robs America’s seniors of the dignity that comes with making these difficult decisions in their waning years. It is a disservice to humane hospice and in-home care, and it insults the intelligence of responsible Americans seeking candid medical advice on extremely sensitive treatment options. This debate is more “sound and fury,” another sidetracked discussion where political rhetoric displaced policy debate.
To get the health care dialogue with the American people back on track, President Obama needs to step up and address these issues directly, along with making the case for comprehensive health care reform – not just health insurance reform – starting with a national focus on wellness and prevention.
The American healthcare debate has taken a turn for the fanatical. An overzealous constituency, bolstered by a media more interested in the next big controversy than the next big policy breakthrough, has snatched the microphone from the nation’s political leaders and temporary drowned out any semblance of a coherent, meaningful debate.
I cherish the First Amendment. I believe that elected officials need town hall forums to effectively represent their constituents. And I am happy to see the public taking an active role in the discussion.
However, as much as it is someone’s right to speak, it is another’s to be heard. And as much as members of Congress need to listen to their constituents, their constituents need to do some listening of their own.
Reforming healthcare to achieve a cost-reducing and long-lasting system is far more complex than many rally-criers would suggest. Crafting a viable reform bill is an intricate process which brings many potentially competing interests – lawmakers, insurers, lawyers, doctors, pharmaceuticals, interest groups, employers – to the table. Boiling viewpoints down to polar opposites and then boiling over in public rage simply distracts from the true goal: affecting a cost-reducing and integrative reform.
The media, particularly partisan talking heads, shoulder every bit as much of the burden for the confusion, mistrust, and misplaced rage streaking the landscape. The nation needs news anchors to play a role in moderating a complicated discussion. Instead, they are juicing ratings with a turbo charged focus on controversy. News coverage has stoked partisan flames, distracting from the issue.
All things considered, I’m left to ask myself: what are the policy implications of all this? What does it mean for democracy when our politicians cannot have a discussion without being shouted down?
As far as the future health of American democracy and civil discourse, this recent rash of extreme activism has the possibility of discouraging politicians from engaging face-to-face with their constituents on hot-button issues. What rational person runs for office hoping for wrathful constituents to berate her?
At heart, I believe the media pundits and town-hall attendees mean well. Though lacking tact, they have reflect viewpoints that are (in theory) based on what they believe to truly be in America’s interest. But they are going about it all wrong. Debate is only possible when other side will pause and listen. An argument without a counter-argument is just a lot of yelling.
Obama has surrendered policy to politics. Here’s a workable proposal to get health-care reform back on track.
Courtesy of BusinessWeek.com
Health-care reform—version 2009—is heading for a train wreck. The debate in Congress is generating more heat than light. While senators and congressmen are on August recess, they are getting an earful from worried constituents, who sense the flaws in proposed plans. The Obama Administration would be well advised to take its own recess to develop a sound, workable policy proposal that can be reintroduced in the fall.
By focusing on politics instead of policy, the Obama Administration has erred in letting Congress create an unworkable reform. The final health-care legislation is being severely compromised by myriad lobbyists and special interests who advocate to protect their turf but rarely contribute to sound long-term policy. Already numerous side deals have been cut with industry groups that make a noncompetitive market even less competitive. The bills under consideration will only make a broken system worse, resulting in unintended consequences.
Health care already accounts for one-sixth of U.S. gross domestic product, and this legislation pushes it toward one-fifth. The system is extremely complex with many interlinked parts. Of the four major elements of health-care— access, cost, quality, and consumer focus on wellness and prevention—current reform efforts address only access to insurance. By tinkering with just one aspect without looking at the whole picture, the President and Congress risk destabilizing the system further.
Granting access to health insurance to all Americans is a worthwhile goal. However, we cannot do so without addressing problems of ongoing cost escalation, major quality issues, and unhealthy lifestyles. The risk in ignoring these other three areas is runaway costs that could bankrupt Medicare while producing convoluted legislation that satisfies no one.
AN AFFORDABLE HEALTH-CARE PROPOSAL
What’s needed is an approach that enables all Americans to gain access to health insurance while incentivizing them to adopt healthy lifestyle practices and rewards their providers for reductions in spending. Here is an integrated proposal for achieving all these goals on a fiscally sound basis:
1. The greatest risk to individuals is facing catastrophic events without insurance. Instead of providing full insurance coverage, the government should sponsor self-funded low-premium, high-deductible catastrophic coverage plans. Catastrophic coverage would kick in after the individual absorbed the deductible. To reduce deductibles, consumers could pay higher monthly premiums.
2. To administer these plans, the government should set up insurance cooperatives that require mandatory portability for workers changing jobs and no limitations for pre-existing conditions, so that no one would fear loss of health-care coverage. These cooperatives would be self-funded and run independently under rules set by the government. All billing would be handled electronically to eliminate paperwork.
3. To address lifestyle issues contributing to the high cost of chronic disease, the federal government should launch a national wellness and prevention campaign—much like the smoking cessation campaign—focusing on sound nutrition, physical fitness, stress management, and reduction of obesity.
4. The federal government should partner with state and local governments to expand community clinics that provide basic services for modest fees and teach people how to improve their health. These clinics would also help consumers access the massive amount of health-care information available on the Internet. This approach puts responsibility for healthy lifestyles where it belongs—on individuals, with support from their caregivers.
5. To promote quality outcomes for chronic disease, the government would shift from reimbursing procedures to paying for keeping people healthy. Physicians and hospitals would be paid for keeping people well, not doing more procedures and tests. Physicians and caregivers would develop integrated approaches to patient care, rather than automatically opting for high-tech, high-cost approaches.
Comparative effectiveness studies would help patients and physicians choose the most cost-effective, proven procedures for treating chronic illness, including accelerated approval of generic drugs after patents expire.
6. Changes in tort laws should be enacted to protect physicians and hospitals that follow these procedures from punitive damage claims, thereby reducing the malpractice claims and class action suits that dramatically drive up costs.
7. To address high end-of-life costs, patients would shift to hospice facilities or their homes where they would receive palliative care.
By focusing on wellness and prevention, consumer empowerment for healthy lifestyles, improved quality in chronic disease management, and reducing overuse of health care, excessive paperwork, and end-of-life costs, this integrated plan ensures affordable access to all Americans while addressing the major elements of health-care costs.
The only costs of this program would be for a national health and wellness campaign and funding community clinics. These costs, a fraction of the $1 trillion price tag being considered by Congress, would more than pay for themselves as citizens choose healthier lifestyles.
This is the only way that we can ultimately ensure health coverage for all American citizens and high-quality, cost-effective care that strengthens our economy and builds a healthy population.
