Grading National Health Reform
The Sweet Smell of Change in the Air
The days are getting longer, the temperatures are getting warmer and winter will soon be a distant memory. Yes, spring is in the air and for many - the spring season is symbolic of change.
But our weather isn’t the only ‘big change’ we are experiencing this spring. Sunday’s historic health reform vote also signaled a major change. After almost a year of contentious political wrangling, President Barack Obama just signed the new health reform bill into law.
The importance of this moment in time cannot be grasped by looking at the process of the past year. Indeed, for many, the greatest distaste over the legislation is the nature of how our politicians did not come together to create change, but played to our fears and extremes. The partisan final votes leave us uncertain about the future of health legislation and the ability to work together on other important national priorities. No, it is in its achievement of fundamental and unfulfilled American values of hope and fairness that this legislation finds its place in history.
There are many analyses now of what the bill includes and what it doesn’t. We will include our own deeper analysis in the coming weeks, based on our formal national health reform policy statement and principles. For now, let me provide my own personal grades, based on our policy priorities:
Universal Participation: A-. The estimated 32 million Americans and 400,000 Washingtonians who will move from uninsured to insured is the largest leap in assuring health coverage for Americans since Medicare in 1964. It closes most of a moral failure in the American health system in one large bite. Some of the new regulations on insurers will also make this coverage more real than theoretical to those in need of health care.
Prevention: B. The national health reform bill contains the greatest advance in comprehensive American health prevention policy in perhaps the last 50 years. While there have been major advances over time for particular diseases, such as cancer, heart disease and diabetes, the fundamentals of creating a healthier society have suffered through an overemphasis on disease and medical care system specialization. In concert with the new funding for prevention included in last year’s stimulus bill, federal health policy is shifting to a far wiser place with respect to health and prevention. What’s missing is how you really work with people to create change- at the personal level, in local communities and with statewide policy makers.
System Redesign and Cost: D. There is far more assertion of success here, than real national policy that can achieve a more effective and efficient system. Productivity gains in the health care system have lagged for decades, and the reform bill maintains the fundamental structure and pace of change contained in past policy. While we accept the conclusion that there are “budget savings” to the deficit through this legislation, these have been achieved through income redistributions rather than fundamental policy change that can alter supply and demand or the productivity of the system (beyond the potential of better prevention policy). Consumers are left to take the complicated and fragmented health care system largely as it is, with promises of future change through pilot projects around ideas that have largely already been tested.
With those grades in mind – let us take a look back at how we came to this health care crossroads. And the role our Healthiest State Campaign has played along the way.
The quest for a more hopeful, fair and rational health care system began in the early 1900’s, when technological advances changed health care from a process of managing death to more helpful and hopeful interventions. Deaths declined, and many once fatal illnesses became treatable. Suddenly, health and health care were viewed as something “good”, not necessarily in an economic sense but in its nature of benefiting people and communities.
Almost immediately, it became important to find a way to spread the services and tools more broadly to people across the nation, and to reconcile it with our developing industrialized economy. Just as quickly it became clear that this would stress our historic distribution systems and our finances, and the problems of health delivery took root in the 1920’s. National leaders, especially in the private philanthropic world, got together to contemplate solutions, adopting a still relevant set of major policy recommendations in the “Committee on the Costs of Medical Care Report” of 1932.
Since that time, we have been in a protracted multi-decade journey to achieve these recommendations, along with thousands of other suggestions for fundamental improvements to American health and health care drafted over the past 75 years. To be sure, there has been some progress along the way. But in very incremental fashion, and in a way that aggravated the underlying systemic problems. A system that was allegedly “in crisis” in the late 1970s as it careened toward 10% of the Gross Domestic Product is now slated to cross over 20%in the next year or so.
I have believed, since my career began back in the late 1970’s, that major change of the system was necessary. Not because of the failings of the people in the system, but rather the design of the system itself. This latest round of legislative health reform was the 4th in my career, with all of the others ending in failure. This time, I was honored to engage in it through my leadership at the Washington Health Foundation, and in the past 6 years, via our innovative Healthiest State in the Nation Campaign.
Our early intent, starting in 2001, was to create a framework for change that could have a greater chance of success nationally and in this state. We did this by going to the public and trying to understand what people saw as the issues, and what values drove their interest in solutions. “Greater fairness through a redesigned health system within existing resources” is the short conclusion of this work from 2002-2004. From 2004, our aim became to build momentum for the larger changes needed to achieve these values, in both health reform and through the parts of the system that affect people and organizations on a daily basis. And it needed to be done in the context of health improvement, not just more medical care.
Our value came from some of our unique solutions, and the voice for change not as a “special interest group”, but as a desire to improve health for the people of our state and the nation. We didn’t need any special deals from the legislation, and our aims stayed true to the public solution values. As the politics heated up, and the special interests became more important to the process over the last 6 months, our voice was crowded out. But - I like to believe the urgency, aims, and public interest of our message endured to the end.
Even as the health care battle draws to a close, we have already committed ourselves to the next phase of major change needed to redesign the health system - working with people to build a Health HoME. A Health HoME
will allow people to take control of their own health. We will also continue to support local community change efforts, and try to build state policy consensus for better prevention policy. More on our future efforts to make Washington the Healthiest State in the Nation soon.
Instead, let’s celebrate this spring season of change. Celebrate, that a long awaited winter of health system failure has come to an end. To be sure, there is more winter chill waiting down the road, but the success of this legislation is something that transcends lifetimes. Let’s enjoy the moment. Allow me to thank the many staff, volunteers and supporters like you who have helped our Foundation and its Healthiest State in the Nation Campaign contribute to these changes. Well done!
