Health Reform - Too Big To Fail?

I awoke this morning thinking big.

I thought of Peter Drucker (1909-1995), who wrote,”Every major social task ,whether economic performance or health care, education or the protection of the environment, the pursuit of new knowledge or defense, is being entrusted to big organizations, designed for perpetuity...On the performance of these institutions, the performance of modern society – if not the survival of each individual – increasingly depends."

I thought of President Obama and his big plans to reform everything big in sight. In the preface to Obama, Doctors, and Health Reform, I wrote, “ President Obama vows to overhaul the health system. He seeks to lower costs, expand access, increase efficiencies, and cut spending. He proposes spending more than $1 trillion over the next ten years to reform it. He seeks to lower costs, expand access, increase efficiencies, and cut spending …Under any circumstances, I don’t foresee how Obama in the next few years can create 3.5 million jobs, redesign the health system, save the auto industry, reinvent the energy sector, revitalize the banks, and reform education with one swipe of his magic wand. “

I thought of the big health care debate now raging in Congress, with the fate of 1/6 of the big $12 trillion American economy and the health of 310 million Americans at stake.

I thought of the big national debt, now projected at $9 trillion by 2019, and I thought of the big unemployment figure of 10.2% for the entire economy, and the big employment figure of 14 million Americans employed in health care.

I thought of big business and an email I received yesterday from Brian Klepper containing a blog from The Health Care Blog entitled,”Will Business Force Reform Back to the Drawing Board?" which contained this passage,

“Non-health care businesses comprise about six-sevenths of the economy - meaning they have six times the heft and influence of the health care industry - and financially sponsor coverage for more than half of Americans. Year after year, employers have borne the lion's share of onerous health care cost increases, 4 times general inflation over the last decade. Endless reports have described how health care, business' largest and most unpredictable benefit cost, has sapped America's global competitiveness and placed its employers at a severe disadvantage.”

I thought of the string of big new bureaucracies, estimated to be 32 in all, that will be required to implement either the House or Senate plans.

I thought of big words and phrases, all abstract, all three syllable or more, that you hear so often and that are said to be needed to restructure the health care system.

Among these words and phrases are,

• Transparency

• Competition

. Infrastructure

• Information technologies

• Meaningful implementation

• Comparative effectiveness

• Evidence-based medicine

• Independent commissions

• Regional variation

• Comprehensive coordination

• Universal coverage

Finally I thought of the growth of health care businesses, as exemplified in The Lorax, a Doctor Suess story I used to read for my children.

The Lorax went like this:

Business is business!

And business must grow

regardless of crummies in tummies, you know.

I meant no harm. I most truly did not.

But I had to grow bigger. So bigger I got.

I biggered my factory. I biggered my roads.

I biggered my wagons. I biggered the loads.

And I’m figuring

On biggering,

And biggering

But if biggering reform fails, you run the risk of harm, whether you meant to harm or not, of setting back needed reforms for years.

As that point, I thought of another polysyllabic word, “incremental.” Rather than run the risk of big failure, which might take years to repair, why not grow into bigger reforms by “chunking,” building towards larger reforms by putting into place smaller doable reforms – like tort reform, opening up health plan markets across state lines, giving people choices of plans with basic benefits and small premiums