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Health Care Reform
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January 28, 2008

An Alternative Plan

Some closing thoughts about Families USA Health Action 2008

By Brian Klepper (from Health Action 2008)

A wonderful meeting (Full disclosure: They brought me in to blog my impressions.), The Families USA conference that ended Saturday brought together some impressive Congressional politicians - Nancy Pelosi, Tom Daschle, Ken Salazar, Blanche Lincoln - and true health care experts - Don Berwick, Tony Fauci - with "consumer advocates" from around the country.

I thoroughly enjoyed the people at the conference. They were, for the most part, knowledgeable about health care and committed to driving a better system. (My favorites were a group of California Gray Panthers, all of whom were VERY up on the issues). There were also bright young people relatively early in their careers, and representatives from community health advocacy organizations around the country, all fervently dedicated to a better, more equitable health system.

My concern was that I believe this group under-appreciates the influence of health care lobbies over Congress and the policy process. They WANT things to change for the better, and they advocate for approaches they KNOW are more logical and reasonable than the way health care is currently done. So why WOULDN'T we do it that way?

The answer, of course, is because it would damage Congress' largest contributors. Almost every politician I heard speak patronized this crowd, making a point to tell them that their input was vital. Would that it were so. If it were, Congress wouldn't take the money it does from health care interests throughout the continuum, and shape policy for their benefit rather than ours. And, please note, the lobbying rules didn't change substantially when the Democrats retook control.

Families USA's leader is a warm, brilliant, articulate guy (and great dancer!) named Ron Pollack, who has guided this organization for years and made it into the health care consumer advocacy powerhouse it is today. He has a clear, unifying, noble vision for how American health care ought to be delivered and financed, evidenced by the caliber of speakers who agreed to talk at this conference.

Unfortunately I don't believe we can get there by relying on consumer advocates. Ardent and well-intentioned as they may be, they lack a power base, and simply cannot compete with large corporations for the attentions of Congress. I hope I'm wrong about this, but this is why I doubt that meaningful reform will take place after the elections. Even if we get a President who is disposed to real change, getting there will require that Congress go along, and they're beholden to the health care industry.

Families USA has built a formidable platform. There's no reason why, quietly, discretely, this group couldn't reach out to certain non-health care business leaders and groups, explain how their interests align with those of non-HC business - we all seek a more stable and sustainable health system that allows the nation to be healthier and more economically competitive - and facilitate a new coalition that could overwhelm the power wielded by the health care sector. After all, they're 1/7th of the economy. Non-Health Care business is 6/7ths.

They're just looking for someone with a compelling reason and a plan to come together, and help us all resolve this issue so we can get on with other equally pressing matters that face the nation.

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by Health Commentary
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Comments
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January 28, 2008

Non-health care sector vs. health care sector

Why do major employers tolerate the current system?
Brian, I like the logic that if the non-health care sector's 6/7th of the economy got their act together then they could pull a powerplay on the 1/7th of the economy that is health care-based.

I've wondered for a long time why major employers have tolerated a costly private insurance-based health care system instead of putting their backing behind a government-based single payer system.

So, tell us Brian, why do big employers stick with the status quo? What's holding them back from pushing for a single payer system that can provide substantial savings?

Also, what's now going on with GM? In 2005 there were plenty of stories about how workers' health insurance was costing GM $1,500 a car.  Then, GM worked out a deal with the autoworkers to cap employee contributions, as I understand it. So what effect has the GM deal had on other big employers who are concerned about rising health costs?

Thanks for your thoughts.
by Tom Linden
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February 01, 2008

The Leadership Problem

Non-Health Care Business Leaders Must Drive Change
It is a great mystery to me why it has been so hard to get the Fortune CEOs to come together on this issue. That said, there are several who have focused on the issue - Jim Sinegal from Costco, Howard Schultz from Starbucks, Michael Critelli from Pitney Bowes, Craig Barrett from Intel, Lee Scott from WalMart, Steve Burd from Safeway - but they haven't done so in an organized and strategic manner. Most often they have announced their intentions, typically backed by some philosophy of what the problem really is, made some sort of stab at it, and then gone back to their real jobs. See this article about a brief foray into announcing their displeasure by Sinegal and Schultz two years ago.

Often they hand this stuff off to their VPs HR, but they typically don't have the authority or cachet to do anything beyond simple programmatics.  Other times - this has been the case with Steve Burd - they've decided that they should partner with industry leaders. When Burd announced his effort he was shoulder-to-shoulder on the Congressional Steps with the CEOs of health industry leaders - Aetna, CIGNA and Medtronic - that was a clear signal that his effort wasn't going to lead any change that mattered. By the way, the same reasoning holds for the effort now being pushed by Mark Ganz, the CEO of Regence BCBS.

So all in all, I think that its a combination of a lack of leadership, a lack of strategy, and a willful avoidance of the public conflict that would inevitably occur.

As to another comment you made, while I'm agnostic on the issue of commercial insurer/single payer, I think its important to point out that there's little or no good evidence that moving to single payer would save money. Medicare is a single payer system, and - see this post - the data are clear that Medicare and private coverage health care inflation have tracked one another very closely over the last 40 years, with average annual growth of 2.5 points greater than general inflation.

The deeper issue is that, despite the finance sector's complicity in the health care cost explosion (which is the real root of the crisis), the biggest drivers of HC inflation have been in the supply chain and care delivery sectors. Movement to single payer would do little, if anything, to address that. More substantive solutions are available through pricing/performance transparency, significant investments in management infrastructure (EHRs, compatible enterprise-wide IT), evidence-based clinical and management guidelines, and tying payment to results.

As to GM, it wasn't any sort of innovation, but a straightforward transfer of responsibility. The UAW, in taking on the risk, suddenly switched its position. Rather than simply demanding, as they have for several decades, that every one of their members should have unlimited access to any doctor and any kind of care, appropriate or not, with GM paying for it, they now need to husband the pool of money they have to work with. There's a law of the universe that says that the guy who owns the risk is going to have a very different management philosophy than the guy who simply receives the benefits, and that's the transition they've made. But their deal isn't particularly generalizable to the rest of American business, or at least the rest of business that's non-unionized.

by Brian Klepper
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