Government reform - Goring Someone Else's Ox: Why Reform is Hard

“Over the long term, reform is only likely to come in response to a major war, depression, or large scale unrest”.

Victor Fuchs and Ezekial Emanuel, “Health Reform: Why? What? When?, Health Affairs, 2005

In Voices of Health Reform (2005), I argued comprehensive health reform is unlikely because it always gores someone’s economic ox.

In the Oct.25 NEJM, ”Learning from Failure in Health Reform, “ Jonathon Oberlander, PhD, an academic at UNC in Chapel Hill describes the strength of the ox and why it’s still alive and kicking.

First, “The status quo is deeply entrenched and despite its failings, the system is remarkably resistant to change, in part because man constituencies profit from it.”

Second, “Many Americans are satisfied with their own health care arrangements, so reforms that threaten those arrangements risk running afoul of the voting public.”

Third, “Expanding government authority over a health care system that accounts for more than $2 trillion and one sixth of the economy in a country that is ambivalent about public power is an inherently controversial exercise.”

Fourth, “Paying for health care remains a formidable challenge.”

Fifth, “U.S. political institutions limit presidential power, foster divisions in Congress, create opportunities for those with vested interests to block change, and generally complicate the adoption of health care reform.”

Sixth, “The window for enacting a comprehensive plan for health care reform never stays open for long, so failure comes at a high price – namely, the loss of political will to do anything about the uninsured for some time to come.”

Which leads to this perverse verse,

The Ox, The Pox, and The Fox

There once was a hurly burly health care ox,
Wonks and liberals placed on this ox a pox,
Which declared greed and profit aren’t fair,
And should be removed from health care,
But the ox turned out to be a ferocious fox.

For publications related to this topic, see Sailing the Seven “Cs” of Hospital Physician Relationships, The Voices of Health Reform, Innovation-Driven Health Care, And Who Shall Care for the Sick?