Four Obstacles to Health Reform

In Obama, Doctors, and Health Reform (IUniverse,2009), I describe four obstacles to health reform with these words,

• Culture, American style, abhors the word “rationing.” Our health care culture cherishes unlimited choice, quick access to the latest and best in medical “cures,” and proven lifestyle restoring technologies. These traits conflict with a centralized, command-and-control, federal expansion of health care.

• Complexities, American health care is a whirling Rubik’s Cube, with millions of interrelated moving parts, institutions, and people, each with agendas, axes to grind, and oxen to gore.


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

• 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 fastest growing employer in town. Collectively, health care profoundly impacts most communities’ economies . Health care’s building blocks can’t be downsized quickly or dramatically.

Well, I’m pleased to report Gerald F, Seib, in an article “U.S. Psyche Bedevils Health Effort", in today’s Wall Street Journal, describes these obstacles in more picturesque and colorful terms as five factors (I have shortened his account for purposes of this blog, but I strongly recommend you google his entire column at wsj.com.

" One, The Marcus Welby factor. Americans maintain a gauzy, almost dreamy image of doctors and nurses. The image of the preternaturally soothing hometown doctor portrayed on television's "Marcus Welby, M.D." is the ideal to which Americans cling. The clinical discussions of cost-effectiveness, reimbursement rates, insurance exchanges and "best practices" that go along with the health debate are wholly at odds with this image of tailored medical care.

Two, The Rube Goldberg Factor. The very fact that the current system is like one of those overly complicated machines means Americans have no earthly idea how much they're paying for health care, which is even more costly than most realize. Thus, they are stunned when confronted with reform plans that lay out the costs -- not just the new ones, but the existing ones. They get sticker shock.

Three, The Company-Town Factor. It's mostly an accident of history that America has a health-care system in which employers pay most of the cost of insurance. This has fostered a view of employers as either paternalistic guardians who look after our health for mutual benefit, or as powerful overlords with an obligation to do so. Either way, there now is a deep fear of both the notion that individuals would be better off fending for themselves (the conservative impulse) or that government ought to take over the job (the liberal impulse).

Four, The Post Office Factor. Americans are deeply cynical about government's ability to do anything right. Putting a man on the moon, building an interstate-highway system, fielding history's most lethal army -- nothing has changed that. Even Mr. Obama makes jokes about how standing in line at the post office has convinced him he doesn't want the government running private firms.

Five, The Job-Machine Factor. This is a vastly underappreciated element of the national psyche. The health system isn't just something that provides medical care; it's now also the largest industry in the land. It provides more than 14 million jobs, the Bureau of Labor Statistics tells us, and seven of the 20 fastest-growing occupations are health-related. More than that, health care will generate a staggering three million new wage and salaried jobs in the next decade or so, more than any other industry."