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June 08, 2009

Health Care Reform: Two out of Three Ain't Bad?

Folksy ads for a local furniture store chain 'round these parts proclaim "quality, comfort and price; that's nice."  In the continuing saga of slouching towards health care reform, we need to deal with quality, access and cost.  The problem is, we can't really do everything at once. 

Now that Obama has weighed in again on the subject -- the weekend radio and internet address, following on the heels of his letter to a couple dozen senators on health reform priorities -- Paul Levy has quite the discussion going at his blog, Running a Hospital, after suggesting that not all of the President's goals can be achieved at once.  We're in agreement that the health care reform effort is balanced on a three-legged stool, and I would concur that the current discussion in Washington is tending more towards the let's-fix-everything-all-at-once end of the spectrum, which is untenable.  I've said it before and I'll say it again: what we need is incrementalism, baby.

Here in the People's Republic of Massachusetts, we started with coverage, which is as good a place as any.  I would observe, though, that the starting point (along with a variety of other characteristics of the Massachusetts approach) are idiosyncratic and a product of the political wrangling/horsetrading that went on in order to get all stakeholders into the big tent.  (We're experimenting in just one of 50 laboratories here.)  Another (larger) playing field, and different (more) players are likely to yield a different set of compromises.  And that's OK, as long as the ball gets moved a bit further down the field (to mix a few metaphors).  I thought Obama's earlier approach, circa White House Health Care Summit ("you know what I'm looking for, guys; send me a bill I can sign") was politically brilliant; getting down and dirty on the details should be left to the operatives, so that Chuck Grassley doesn't get to score points by tweeting about Obama sightseeing in Europe over the weekend (though, gee, did he forget it was D-Day?).  I thought Obama better appreciated the need for results in this arena vs. taking the opportunity to do a little grandstanding.

So, I'd like to see Obama back off: more looking Presidential; less arm-twisting.  Staking out the range of options to be considered is a good thing, and hanging back a bit until there's a solid bill on his desk -- understanding that the White House is certainly involved in the private discussions leading up to such a bill being finalized -- would be even better.  Seems to me that's the clearest way forward for now.  While there is the potential for taking some giant steps this year, I'm OK even if the end result is less ambitious than is now hoped for.  Why?  Because I believe incrementalism is the way to go here, and it will end up being the first step of a long journey.

If you're interested in discussion of the leading health care reform policy and payment options on the table, please join Gregg Masters and me on Blog Talk Radio this Thursday, June 11, 12:00 Noon Pacific, 3 PM Eastern, and follow the continuing conversation here, there and on twitter.

David Harlow
The Harlow Group LLC
Health Care Law and Consulting


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