Tuesday, August 11, 2009

Reforming Health Care in the US - Lessons in How Not to Manage Change

Sarah Palin is promoting the strange idea that the Obama health care reform includes a provision for Government agents to visit the elderly and determine when and how they should die. The so called “death panel” does not exist, has never existed nor could it ever pass a vote in any legislature in North America. Yet some seemingly smart people are convinced it is in the Bill now before congress.

One reason there is so much passion and anxiety about health care reform is that we can all imagine ourselves needing care, especially those of us who have needed care in an emergency. When someone threatens to change what we think we have as a right or service, we naturally get concerned. When the changes are not well understood, all that happens is that anxiety increases, passions are inflamed and rumours replace information as the basis of public concerns.

We see this is spades in the debates now raging across the US. In addition to the death panel rumour, there are also concerns that the bill will lead to the US Government being the single payer in health care – what some call socialized medicine, which is also not true. If the bill that passes congress continues to include a public insurance option – the Government offering a plan which individuals can opt into – it is also unlikely to significantly impact the private health care insurance business, which has profits last year of $30 billion.

The bill before congress contains the intention to limit the type of medical procedures that the government would fund in a government program and through Medicare and Medicaid (both government runs programs, along with the Veteran health programs). Opponents of the plan don't want the government to fund any procedures. So, how is restricting the procedures funded through a government plan rationing? Anyone who wants to is entirely free to buy as much health care as they want outside of the government-subsidized plan. However, many of the supporters of the Bill have signaled a willingness to drop the public insurance option.

Another compromise that the White House has already agreed to is a back-room deal with the pharmaceutical companies to limit the extent of cost cutting for drugs – one of the fastest growing costs of health care – to no more than $80 billion. Also included is an agreement to ban the import of lower costs drugs from Canada. These arrangements limit the extent to which reforms will reduce health care costs over time.

There is a claim, this time by the proponents of the Bill, that doing nothing is not an option, since the costs of health care are running “out of control”. The projected $1 trillion cost over the next decade is equal to about 0.5 percent of US GDP, less than half of the cost of Iraq-Afghanistan wars at their peak. The $250 billion ten-year shortfall that Congress is struggling to fill is a bit more than 0.1 percent of GDP - a rounding error in the total budget approved by the US congress.

The focus, at least during the Presidential campaign, was on ensuring that the 46 million Americans who do not currently have access to health care insurance would do so as a result of the changes Obama and the congress propose. The bill now before congress would help some people have access, but would not reach all of these disenfranchised health seekers – at best it may help an additional 10 million. Obama claims that an additional 36 million may benefit, but few support the math behind this claim.

When we watch the town-hall meetings, we can see the passion and the concerns. We can also see the division between the right and left, the informed and the ignorant and the hysterical and the calm. Anyone wanting to secure real change in health care will need to do a much better job of explaining, without seeking to score political points, what it is they wish to change, why they wish to change and what the implications of that change will be on different groups in the community. Until this happens – and it is not happening yet in the US – decisions will be made on the basis of rumour, innuendo and guesswork. A responsible media would help to improve the quality of debate.

In Canada, we will also need to look at changes in health care over the coming decade. We should watch with interest what happens when reforms are attempted and how vested interests seek to manage and control the debate. It makes for entertaining news, but is also disturbing.

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