I’ve been at odds with other commentators ever since the battle over health reform was launched early this year. In contrast to conventional wisdom that reform was a “sure thing,” I have consistently estimated a 30% chance for a major legislative overhaul. My crystal ball has always indicated that the forces against meaningful reform were slightly more than twice as strong as the forces that could make it happen. (I really do have a crystal ball on my desk.)
My approach to forecasting the prospects for health reform over the past year reflects my original training as a weatherman. (I really was a meteorologist back in the 1960s.) Forecasters learn to estimate the probabilities of possibilities by evaluating the relative strength of forces that could lead to different outcomes. I have consistently perceived that the serious economic downturn, competing national priorities, deep divisions within the Democratic Party, and absence of a shared vision of reform would be very tough obstacles to overcome.
Now that the Senate has passed its reform bill, I have received a few calls to see if my forecast has changed. It has not, for three reasons.
· The Senate and House bills are very different on polarizing issues that matter a lot to key members of both chambers. Forging an acceptable compromise between divergent wings of the Democratic Party will be very difficult (but, admittedly, not impossible).
· Approving the Senate bill required last-minute compromises and special arrangements that challenge the interests of key stakeholders. Their lobbyists will be out in force, trying to undo the tenuous coalition created to get 60 votes.
· Neither chamber’s bill reflects a realistic plan for actually improving health care in the United States
Being a strong advocate for improving our health care delivery system, I’m not happy with my contrarian forecast. However, I learned in my meteorology days to base my forecast on the likely outcomes of the forces at play, which was not always the weather I wanted. I also learned that people love to make their own forecasts. So, step out on a limb with me and share your forecast. What do you think is most likely to happen, and why?
2 comments:
Perhaps it is not realistic to expect that we can fix health care with one go-round. Should congress pass the flawed legislation currently on the table? Maybe passing the legislation on the table would open the door for a series of incremental legislative changes that would eventually be the fix we all desire.
Anonymous has asked the $64,000 question. It cannot be easily dismissed. As a strong supporter of health reform—with dozens of articles and books detailing the changes I favor—I have agonized over the answer. However, as political reality dashed widespread hopes for a comprehensive approach to overhaul the system, I have shifted toward the view that no reform is better than misguided and/or misleading reform right now.
My principal reason for reaching this conclusion is elaborated in two previous posts, “What are the foundations of meaningful reform?” (12/15/2009) and “If reform passes this year, will it matter?” (12/8/2009). If a reform law clears the President’s desk in early 2010, I think that the ensuing political battle will most likely be to repeal it, not to improve it, because too many vulnerable deals were made to pass a law. I wish I believed that incremental legislative changes could be counted on to redirect reform in a good direction, but I don’t.
Anonymous is absolutely correct in implying that that health care will take years to “fix.” I am, therefore, disappointed if elected officials produce the “flawed legislation” to which s/he alludes. The most likely effect of passing an admittedly defective law would be another wasted year—2010 spent squabbling over past actions rather than tackling the difficult but essential task of defining the health system we want and then deciding what laws are needed to facilitate moves in the desired direction.
One of my biggest disappointments in the latest push for health reform has been the failure to file a flight plan before taking off on the long journey of building a good health system. As I titled the final chapter in Not What the Doctor Ordered, “How will we know when we get there if we don’t know where we are going?” We should also be deciding how much we are willing to spend on the journey and the destination.
Finally, I fear that passage of a flawed law will force health care businesses to waste a lot of time preparing for legislated changes that will not ultimately occur, due to repeal or amendment. Organizations will be diverted from the imperative for internal reform: doing health care right all the time, as inexpensively as possible. IT-supported performance improvement is the obvious key to reducing costs and improving quality so that more Americans can benefit from the 17% of GDP consumed by health care. Where is prompt performance improvement in the flawed legislation that may be passed in the coming weeks? What am I missing?
Thank you, Anonymous, for your contribution! Others are encouraged to join The Healthy Debate.
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