   |  | | Commonwealth survey says chances for true reform are good | By Mike Magee, MD
If you look back over the decades at promises to reform the US healthcare system, it's been all talk, no action. There are many reasons for this, but the two major ones have been a) the people (at least those who were insured) were ambivalent about change, seeing the risks as somewhat larger than the benefits; and b) the people caring for the people conspired to prevent change, again believing the risks (including those to their pocketbooks) far exceeded the benefits.
Will it be any different this time around? Who knows! Both presidential candidates say it will. So does this summer's Commonwealth Survey on the subject.1,2 According to Commonwealth’s president Karen Davis, "It's clear that our health care system isn't giving Americans the health care they need and deserve." 4
1,004 U.S. adults were polled in May, 2008. Thirty two percent said the whole system needed complete rebuilding, while one half thought it required fundamental change. The bias for change was independent of insurance. 8 of 10 of those with insurance voted for change, while 9 of 10 of the uninsured wanted a new approach. Only 16 percent voted for the status quo.4
Cost, efficiency and equal access to care are the big drivers today. Consider that in the past decade health premium costs have jumped 100 percent, according to the Agency for Healthcare Research and Quality.3 In 1996, the average annual family premium was just under $5,000. By 2006, it was well over $11,000. Premiums for those who are single went from under $2,000 to over $4,000. Employers paid for roughly three quarters of the increase. But their tolerance is declining, as witnessed by recent drops in the numbers of employers providing health benefits, and in the quality of the coverage they provide.4
But it's not just the cost. Increasingly the people, and the people caring for the people, are concerned about the system itself - the rushing, the crowding, the unevenness, the antiquated information systems, the complexity and associated safety lapses and injuries, the workforce shortages, and the absence of a comprehensive vision that would allow Americans to reach for their full human potential as productive and compassionate citizens.
Those pushing reform in the past have argued that we pay more than twice per capita on health care then our neighbor, Canada. Those opposing reform have pushed back - "How would you like to wait a year or more in pain for your hip replacement?" Stalemate!
If we are able to achieve meaningful reform during the next Administration, it will be because we have embraced a meaningful opportunity to surpass rather than mimic someone else's system. It will be because we have appreciated the unique opportunity presented by the intersection of aging demographics, multi-generational family complexity, health consumer empowerment and engagement, and information technology advantages that allow us to re-center and reconnect our system with great efficiency, equity, safety, and quality.
Will it happen this time? Depends on the strength of the vision, which depends on the quality of the leadership. "Yes, but..." is our history. "Yes, and..." is our future.
References:
1. The Commonwealth Fund. Health Policy Reform in the 2008 Election Season. 2008.
2. How S.K.H., et al. Public View on U.S. Health System Organization: A Call for New Directions. Ed. Martha Hostetter. The Commonwealth Fund. 7 Aug. 2008.
3. U.S. Department of Health and Human Services. Identifying, Categorizing, and Evaluating Health Care Efficiency Measures. April 2008.
4. MSNBC.com. Most Americans Want Overhaul of Health System. 7 Aug. 2008.
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