Friday, August 28, 2009

The Health Reform Tiger

“They’re predators. Who can really know what’s on their minds? Even though they’re raised in captivity ,and they love us, sometimes their natural instincts take over”.

Kay Rostaire, Big Cat Trainer, Sarasota, Florida, describing why a tiger attacked Roy Horn, of the Schneider and Roy Show, in Los Vegas

"A guiding principle of any reform should be to put the consumer, not the insurer or the government, at the center of the system”

David Goldhill, “What the Government Doesn’t Get about Health Care,” The Atlantic, September, 2009

When you ride a tiger it’s hard to dismount lest you get eaten. So says a Chinese proverb. The tiger is health reform. The trainer is the American health consumer. The health reform endgame is fast approaching. People riding the tiger must decide how to dismount without being eaten. The tiger is hungry. It will consume more and more people, money, and resources until the consumer tames it by training it to act differently.

The Narrator

I am a retired pathologist and long-time commentator on health reform issues. My work includes books – And Who Shall Care for the Sick (1988), Managed Care Memoir (2003), Voices of Health Reform (2005), Innovation-Driven Health Care (2007), and Obama, Doctors, and Health Reform (2009) - and a blog, medinnovationblog, with 955 entries since 2006. Some say pathologists know everything. but it’s too late. I maintain pathologists aren’t mere bystanders. We actively participate in clinical medicine and observe intermediate and final outcomes.

People Riding the Tiger

People riding the tiger include:

• President Obama, who has staked his legacy on health reform

• Democrats, especially Blue Dogs, who wish to remain in power

• Republicans, who seek to regain power

• America’s seniors and the disenfranchised, now covered by Medicare and Medicaid

• America’s 5000 hospitals, who remain at the center of community care

• America’s physicians, 900,000 of them, whose future rests on the outcome of health reform

• physician-led or affiliated organizations – the AMA, state societies, specialty societies, The Physicians’ Foundation, Sermo, MGMA, and integrated health organizations – who try to guide doctors

• American health plans, 1300 of them with their various agents, who desire to remain in business by administering health reform

• the pharmaceutical industry, who is said to have stuck a deal with the Obama administration to stay on the tiger

• the medical device industry, arguably the most innovative health care sector

• American businesses, large and small, whose economic futures depend on taming the tiger

• health information technology businesses, who in their various guises – EMRs, clinical algorithms, predictive models, data mining, and health 2.0 innovations – hope to create a rational dismounting glide path

• Health lawyers and malpractice attorneys, who need to promulgate fewer rules and regulations and who need to be reined in through tort reform

• all Americans, who are growing increasingly restive, distrustful, and skeptical about what governmental comprehensive reform might portend for them

Cracking the Whip

Consumers – patients- in conjunction with knowledgeable doctors, are beginning to crack the whip. After all, it is their health and safety, not the economic health of those riding the tiger that counts. The most important thing that has happened during this latest health reform tiger ride is reawakening of the survival instinct of patients. They have begun to recognize that their survival and restoration of a full life-style function are at stake.

The enduring lesson of the health reform movement is that consumers have a potentially powerful voice. They are unleashing that voice in town meetings as they press politicians riding the tiger on how they plan to dismount without harming consumers and drowning them and the nation in debt.

Dr. Reece’s latest book, Obama, Doctors, and Health Reform is available on,,, and, or can be ordered through your local bookstore.

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