Tuesday, February 24, 2009

Obama strategies - Obama - Too Much, Too Soon

David Brooks is worried. In his February 23 New York Times column, “The Big Test,” Brooks says President Obama may be trying to do too much too soon.

Obama and his aides “are unrolling a rapid string of plans: to create three million jobs, to redesign the health system, to save the auto industry, to revive the housing industry, to reinvent the energy sector, to revitalize the banks, to reform the schools – and to do it all while cutting the deficit in half.”

And Obama wants to do it all at once – fast - with one swipe of his magic political wand. My guess, as I write in this foreword to my book , Obama and Health Reform: The Health System, from Top-Down to Bottom-Up, as Seen Through Lens of Cultural Complexity, is that he will fail, at least in health care, at least that’s what I say in my foreword, which follows,


President Barack Obama has vowed to overhaul the U.S. health care system. He wants to lower costs, expand access, increase efficiencies, and cut spending. I would place the odds for sweeping reform at 20/80, and odds for incremental changes such a coverage for children, stem cell financing, funding for electronic records, and extension of unemployment benefits to Medicaid as a slam dunk.

I expect other issues now being debated and demonstrated at Medicare – such as pay-for-performance, medical homes, bundling of hospital-physician bills, creating integrated groups, coordinating care, forming a Federal Health Board, creating a Comparative Outcome Institute, and mandatory use of EMRs as a condition for payment –to make slow, uneven, and unpredictable progress.

Otherwise, the debts incurred by the economic stimuli and the staggering federal deficit are simply too steep a hill to climb for those who crave universal coverage or single-payer.

How one at the same time covers more Americans while slashing costs eludes me. Expanding coverage always costs more. I only know one thing- and it’s a big thing. It will be impossible to superimpose a single-payer system on the current system.
I wish the President the best. The present state of affairs – unhappy patients, unhappy doctors, soaring costs, and 15% uninsured – cannot last. At least that’s what we keep saying. Health costs, mainly Medicare and Medicaid, consume 25% of the federal budget, and more cost rises are on the way and are unsustainable.

President Obama faces four towering obstacles to reform. I call them the four “Cs.”

• Culture, American style, abhors the word “rationing. ” Our culture cherishes unlimited choice, quick access to the latest and best in medical “cures, ” and lifestyle restoring technologies.

• Complexity, American health care is a whirling Rubik’s Cube, with millions of interrelated moving parts, institutions, and people, each with own agenda and axes to grind.

• Costs, Obama says prevention, electronic medical records, and paying only for what works, as established through comparative research, will save billions of dollars, yet little evidence exists that these measures work.

• Consequences, of curtailing health costs, may be worse than the cure, because health care institutions and private practices in many communities are the biggest and only growing employer in town. Collectively, health care has a profoundly positive economic impact and cannot be dismantled quickly – if at all.

Given these truths and consequences, I offer in this book my observations, gleaned in part from my writings, in part from conversations with health care people on the ground, and in part from public discourse in the media.

No comments: