Sunday, October 17, 2010

Problems of Preaching Patience in the Impatient Age of Health Reform

Obama is preaching patience in an impatient age.

Peter Baker, “The Education of a President,” New York Times Magazine, October 17, 2010

When I started this blog three years ago, I named it Medinnovation. I had just published Innovation-Driven Health Care (Jones and Bartlett, 2007), and I thought of the blog as a sequel. Then politics intervened, namely the 2008 presidential campaign and first two years of the Obama presidency. I have been speculating ever since what health reform means for grassroots Americans.

President Obama advocates long-term thinking. He seeks to lay down foundations for the future so American can compete in a global economy. His code language goes like this: We must pull ourselves out of the “economic ditch”dug my Republicans. We must “move forward” by embracing “progressive" policies. Above all, we must "Stay the course." Be patient. Good times for you and me will come.

The problem with this policy is that Americans are an impatient people. We’re in a hurry. We like quick results. And we’re always unconsciously asking, “What have you done for me lately?” As the November 2 election nears, the answer to the majority of Americans seems to be, “Not much.”

We are growing impatient as the economy stalls, unemployment persists, national and personal debts grow, and health costs escalate. Despite the Obama administration's reassurances and projections health costs will level off over the next ten years, this year costs will go up an average of 10% for most, and 20% or more for many in individual and small group markets.

Four years is a long time to wait. Not until 2014 will 32 million more of the uninsured be insured and will other benefits become manifest.

It is an especially long time to wait for,

small and large businesses, who must plan annual budgets, who need to know how high taxes and health reform penalties and fines will be next year, what a bite health reform mandates will take out of their bottom lines, and whether or not they can afford to offer health benefits for their employees.

• health consumers and patients,
who must plan their household budgets, who must decide whether to visit their doctor or have that procedure done, who want to know how much more health costs their employers will shift to them, what their next health plan might be, whether they will even have a plan, and how high their premiums, co-payments, and deductible will be.

physicians, who still await the decision of Congress whether to cut 21% out their Medicare pay this year and 26% next year, whether they can afford to accept new Medicare and Medicaid patients, whether they can remain in practice with lower reimbursements, more regulations, and higher expenses, whether they should seek employment by hospitals or larger groups, or whether they should retire or seek a career outside of medicine.

Patient waiting for hope and change are said to be virtues. But how long to wait is another matter altogether. Dashed hopes, delayed results, and dwindling patience are inseparable and more often than not lead to explosive impatience.

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