A crisis in the politics of health care: it's a myth that the private sector can act alone

Chief Executive, The, August-Sept, 2004 by Michael J. Dowling

The threat of catastrophe in our nation's health care system looms large if we continue to ignore the problems posed by the nearly 44 million uninsured Americans or the roughly 70 million baby boomers who will place unprecedented demands on the system as they grow older.

Most political leaders and policy analysts acknowledge the perils, but we're not even close to a consensus on what to do about them. We can't even agree on how to describe the U.S. health care system. It has been called the best and the worst, the most complex and the most fragmented, the most innovative and the most dysfunctional. It provides the best possible care to many--yet very little to others.

Some challenge the notion that it is a system at all. Rather, they define it as a hodgepodge of disparate interest groups, partisan in their approaches and ideologies. Each constituency approaches the issue from its own narrow perspective and exerts all of its influence to protect its interests. As a result, very little gets done. There is, to put it simply, a crisis in the polities of health care.

Constructive change can happen only if all the stakeholders take a broader view and start negotiating with the presumption that they must collaborate and share. Virtually everybody--consumers, employers, health care providers, insurance payers and pharmaceutical companies--must be involved. Far from being independent, we are interdependent. We need each other to make the system work. We should start by trying to agree on a number of basic points:

* Cover the Uninsured. Any reform effort with lasting value has to provide coverage to all. An estimated 43.6 million Americans are uninsured, most of them working families. Universal coverage is imperative if we are to rationalize how the health care system operates. Who pays? Every individual and organization involved in delivering, receiving and paying for care.

* Don't Undercut Medicaid, Medicare. These two federal programs are a life line for more than 84 million Americans. Can they be improved? Of course. But we should approach any changes like a home improvement project, not a demolition job. Medicaid and Medicare are the workhorses of the current system, giving the poor and elderly access to care and services that would not be adequately provided under the alternative plans being discussed.

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Despite criticism, Medicaid and Medicare are well-run programs, neither overly bureaucratic nor unwieldy. Their success contradicts the notion that only the private sector can solve the problems facing our health care system. Market-driven solutions work well in selective areas, but they are not a panacea. We all need to accept that both the public and private sectors can play valuable roles. Once we acknowledge that, we can reduce the ideological baggage that's blocking true reform.

* Define "Quality" Care. There has been a major push to improve patient safety, reduce medical errors and make health care providers more accountable. The industry is already working with business and consumer groups, health plans and government agencies on establishing a set of outcome measures to enable the public to determine how well their local hospitals deliver care. Tying reimbursement to how well hospitals perform is a positive and overdue development. However, the proliferation of so-called hospital report cards hampers consumers' ability to make in formed decisions, because the criteria differ from one study to the next. We need to agree on one set of outcome measures that are an accurate reflection of quality.

* Accept Reality--Costs Will Rise. The notion that health care spending can be reduced at a time when many baby boomers are nearing retirement age is ludicrous. New technologies that enhance the diagnosis and treatment of cancer, heart disease and other illnesses have increased life expectancy and improved the quality of life dramatically. Unless we are willing to curtail the development of these new technologies or deny life-saving treatments, we must pay the price.

It is popular to deride the U.S. health care system, but the truth is that the best medical care in the world is available here. How it all gets funded is a complex problem. Rather than blaming each other, all parties involved, in government as well as in business, must work together to become part of the solution.

Michael J. Dowling is president and CEO of the North Shore-Long island Jewish Health System, a $3.7 billion nonprofit based in Great Neck, N.Y.