I’D LIKE TO SAY THAT, in this first issue of 2008, I’m writing with unbridled enthusiasm about healthcare in the New Year. I’d like to believe that there are a multitude of optimistic signs on the horizon boding well for changes in the healthcare system.
Well, sorry to be a killjoy, but I’m not optimistic at all. That’s what happened after talking to my sister.
Gloria Bazzoli, PhD, is a professor of health administration with the Department of Health Administration at Virginia Commonwealth University. Her doctorate is in economics, and she has spent most of the last 20 years studying the nation’s healthcare system. You’ll quickly figure out that I’m proud of her scholarly achievements and appreciate her insights into the system.
We were driving back from O’Hare International last month during one of her not-frequent-enough trips back to the Chicago area – but then again, who could expect anyone to come to Chicago in the winter? In rush-hour traffic to my house in the far western suburbs, talk invariably turned to healthcare, its woes, its weaknesses and the prospects for reform.
Let’s just say that, after an hour of stimulating but depressing discussion, I suggested that we stop talking about healthcare.
It’s not easy to summarize the scope of our conversation, but let’s just say I came away with the following feelings afterward.
Healthcare needs reform – and it needs it bad. Not just window dressing around the edges, but drastic redesign. The system is just too expensive, too defensive, too inefficient, too bogged down in paper and too intent on preserving revenues and incomes.
There has been a lot of tip-toeing up to the edge of reform, but it’s clear that there’s no stomach for the shared sacrifice that will be necessary to affect major systemic change. Special interests have been successful in hobbling steps to hold the line on spending, and even when rate cuts have been put into place, healthcare organizations have upped volume to maintain revenue levels.
The chances are slim that anyone from the federal level will exhibit the leadership and vision that will be necessary – after all, many perceive that taking a bold stand on healthcare reform to be political suicide. No one seems willing to admit that spending 16 percent of the gross domestic product – and that percentage is rising – is not sustainable for the long haul. And providers won’t lead the charge – they’re averse to risk and willing to tolerate a bad system rather than risk a change that carries uncertain consequences.
Few realize that healthcare systems in other countries can teach us things, and that those overseas look askance at the cost, waste and inefficiency in our system. And let’s get over this idea that our country truly operates a healthcare system – we don’t do enough caring for health, and all the individual pieces don’t work together or share information well enough for it to be classified as a system.
So what will precipitate true reform? My sister expressed the fear that it will take a crisis or event that will galvanize public attention and which can’t be ignored. She believes it might take something on the scale of the subprime mortgage crisis that’s currently roiling the economy. When millions of Americans risk losing their homes, it is obviously a crisis that needs attention.
It’s not clear what could spark that degree of emergency – perhaps a spate of employers might no longer feel they can provide healthcare insurance to workers and remain competitive in the world marketplace. But piecemeal reform of the current system may not be enough. And apparently, 47 million Americans without health insurance is not a large enough number. Perhaps the only way to get people to accept change is if their current reality disappears and the healthcare “boat,” as we know it today, threatens to sink.
I think those answers are out there – among the healthcare economists, the policymakers, the administrators, the caregivers, the patients, the payers and the employers. It will take a group of brave individuals to take on risk, overlook personal and institutional gain to craft a true system that will work for us, for our children and our children’s children. We may not exactly love the final product, but it will work and be sustainable. Let’s not just wait until an inevitable crisis happens before we decide to act.