Health Reform: Big Wind, Take Small Steps

Yesterday’s national polls, conducted by New York Times/CBS News and WSJ/NBC News, and reported today by their sponsors, The New York Times, “New Polls Finds Growing Unease on Health Plan” and the Wall Street Journal, “Support Slips for Health Plan,” indicate the more President Obama talks up and defends his plan, the more skeptical the public becomes.

This slippage brings to mind two things.

One, the story of the mother who who sent her son out on a stormy day and gave this advice,”Big wind, take small steps.”

Two, one of the main underlying themes of my book Obama, Doctors, and Health Reform (IUniverse, 2009). In the book, I predict incremental reform is likely and big reform will not happen.

Here are passages in the book on the likelihood of incremental versus massive reform.

Page 5

Although President Obama strikes a determined, even combative tone, I place odds for sweeping reform at 30/70 in his first term, but as near slam dunks for immediate incremental changes such as coverage for children, stem cell financing, funding for electronic records, setting in motion a Comparative Effectiveness Institute, and extended Medicaid unemployment benefits.

Page 10

Under President Obama, health reform is coming – fast, ready or not. But in my opinion, reforms will be incremental, but we’ll not see the whole enchilada - universal coverage.

Page 144

What are the ultimate answers to the primary care shortfall? If I knew that, I would be a candidate for a combined Nobel Prize in Medicine and Economics. Here are a few evolving development that may offer incremental solutions.

• Government and organized medicine payment reform (read the latter as a new coding system by the reimbursement updating committee of the AMA) that spills over into Medicare, Medicaid, and health plan payments.

• Government subsidies and incentives that ease educational debt for primary care candidates, reward care for primary care in underserved areas, and offer more extensive support of primary care residency slots.

Here are a few evolving development that may offer incremental solutions.

• Government and organized medicine payment reform (read the latter as a new coding system by the reimbursement updating committee of the AMA) that spills over into Medicare, Medicaid, and health plan payments.

• Government subsidies and incentives that ease educational debt for primary care candidates, reward care for primary care in underserved areas, and offer more extensive support of primary care residency slots.

• Federal, state, and health plan support of medical homes with adequate payments for creating these homes and lowering of bureaucratic barriers for physicians wishing to create medical homes.

• Realistic rising of fees for care of Medicare and Medicaid populations to more closely approximate private fees and to end cost shifting now required maintaining viable practices and hospitals.

• Federal, state, and health plan support of medical homes with adequate payments for creating these homes and lowering of bureaucratic barriers for physicians wishing to create medical homes.


•Page 160

I would not bet against significant incremental health reform. What might prevent Obama-style helath reform are the economy, the soaring federal budget deficit, the Department of Health and Human Services current $708 billion budget, and 25% of federal spending going to Medicare and Medicaid. But Obama is not one to let billions, even trillions of dollars in deficitsstand in his way. He will persist, and he will let the government printing presses roll.

Page 221 -

Physicians on the ground prefer incremental changes through expanding coverage through tax incentives and market-driven changes rather than through a single-payer system.

Page 269

Self: Is there any way to fix the system?

Alter Ego: Sure, but it’s going to incremental, it’s going to be painful, it’s going to be by trial and error, it’s going to be by testing and rejecting entrepreneurial innovations, and it’s going to be through an uneasy symbiosis between government and business, with business leading the way in many instances, because its survival is at stake in the global economy and because business can move quickly and decisively. The prospect of bankruptcy in the morning concentrates one’s attention.

To sum up, big wind, take small steps.