Do the thing you think you cannot do

Healthcare Financial Management, March, 2007 by Joseph J. Fifer

I chose courage in leadership for my theme this year for many reasons, some of which are personal and have special meaning for how I journey through my career and my life. But the theme also reflects the significant need for us to lead the reform in our healthcare system. During the past nine months, I have become even more convinced of the need for courageous leadership: doing the right thing for the right reason. How communities approach health care varies greatly. For example, physician employment is legal in some states; in others, it isn't. Some hospitals have scant indigent care; the uninsured make up half the volume in others. Some communities have dominant proprietary providers; others are serviced only by not-for-profit hospitals.

Constants also exist. The U.S. population is still largely unaware of how health care is financed, much less their role in it. The number of uninsured Americans and the hidden tax levied on our business community due to government underpayments both continue to rise. And no solution is in sight. As President Bush said in his State of the Union address: "Everyone in this chamber knows this to be true, yet somehow we have not found it in ourselves to act."

Since assuming the HFMA chairmanship last June, I have spoken out about our need to take the lead in correcting our flawed financing system. Some of my discussions have been hard-hitting, because in many instances, we dropped the ball. In effect, I looked in the mirror and didn't like what I saw.

Now it's also time for the president and Congress to act. I find it unconscionable that our health-care financing system is universally believed to be broken, yet the public sector lacks the courageous leadership to fix it. It's not as if the problem is recent. At my organization, the hidden tax--that is, the loss on Medicare and Medicaid--has risen from zero in 1997 to $89 million in FY07. That amount doesn't even include the impact of the growing uninsured. While some states and communities have stepped into the land of uncertainty with innovative solutions, I see little of that at the national level.

I understand the challenge involved. Reelection is a strong motivating factor, and the healthcare financing fix could put a hurdle on the path to another term. I am reminded, however, of what Eleanor Roosevelt said: "You must do the thing you think you cannot do." It's time, ladies and gentlemen in Washington, to do just that. Let's start with an honest attempt at process, dialogue, and ideas to reverse the trends, provide primary care for our citizens, and eliminate the hidden tax. This journey will be hard and will require involvement by many segments of our society (including healthcare industry leaders), but to do otherwise is simply not right. Let's do what seems like something we cannot do, and do it now.

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We'd like to hear from you. If you have a story about courage in leadership that you'd like to share with hfm, please send it to Carole Bolster at cbolster@hfma.org. Futre columns may include members' stories.

Joseph J. Fifer, FHFMA, CPA

Chairman, HFMA