Wednesday, November 30, 2016

Elements of Health Reform: Lessons Learned

The cat is out of the bag,  the toothpaste is out of its container,  and the genie is out of the bottle.

Trump has been elected.  Tom Price, MD,  a fierce opponents of ObamaCare has been selected as head of HHS,  and Republican leaders have declared repeal and replacement of ObamaCare as first on their legislative agenda.

What are lessons learned from this unlikely turn of events, which will doom Obama's signature domestic program and likely lead to a Republican alternative plan,  as yet unnamed?  What will happen to those 20 million Americans now subsidized on health exchanges and Medicaid?  No one knows at this point, and it is unlikely we will know precisely until months after President's Trump's debut.

In my case,  after 50 years of writing about health reform, I have come to these conclusions.

  • The U.S.  Constitution- The U.S. Constitution,  said by one historian as the greatest legislative compromise, in Western Civilization, is alive and well. Its electoral college provision  held up and will not be overturned. And the checks and balance concept has prevailed, much to the chagrin of Democrats.
  • Failure to Compromise in Bipartisan Nation -Largely because President Obama failed to compromise in designing and implementing the health law,  passing it without a single GOP vote, ObamaCare is now destined for oblivion
  • Rhetoric Not Enough -President Obqma,  a gifted speaker and campaigner,  did not achieve his promised results, filed  to build a Democratic leadership team, and did not listen to the people.  Consequently, he left the Democratic party in shambles
  • Center Right- America is a center-right capitalistic nation that believes in personal responsibility,  economic prosperity,  and equal opportunity rather than government control,  economic stagnation, and equal  outcomes. 
  • Limits of Centralized Government -A centralized government cannot manage individual choices at the level of doctor-patient relationship.
  • Health  Costs Difficult to Control   -Health care costs are difficult to control when comprehensive benefts are offered but not deliveredand because everybody wants to live another day and because , in the words of comedian Berle, "When it comes to my health, money is no obstacle.
  • Demand for Lifestyle Improvement-One of the untold tales of health reform is the demand of aging patients for access to life-style technologies - joint replacements and cardiac stents -  that support their lifestyle.
  • Ignoring of Insurance Risk - ObamaCare did not lower premiums or deductibles because it made calculations of actuarial risks impossible  and did not take into consideration that insurance is based on balances the costs of illness against health.
  • Absolute universal coverage, noble in intent but impossible in attain America, which cherishes choice, individual freedom, and access to the best medicine has to offer,  cannot be acheived in America
  •  Nature of Humanity -  People, being human and not robots,  will continue to behave badly and ignore habits of good health in search of earthly pleasures  as long as health technologies offer an out.
  • Freedom of Choice - Freedom of choice of doctors and health plans and hospitals are part of the fabric of American culture.
  • Benefits of Prosperity - Beleif in economic growth as a universal solvent for most problems is embodied in President Kennedy's statement,  " A rising tide lifts all boats, and in the provess etends to soften or paper over social inequities.
  •   Orwellian Observation - In Animal Farm, George Orwell commented, "Some animals are more equal than others." This applies to health reform, even is Big Brotther is watching.
  • Unequal Blessing, Equal Miseries -  Winston Churchill said, Capitalism offers unequal sharing of blessings,  while Socialism confers equal sharing of miseries.
  • Necessity of Organizations -  In the complicated world o health reform.  most advances require organizations managed  growth and perpetuity operating within the matix of indvidual ezcellence.
  • The fuure excellence of American health care  depends on govenment and private orgnization working in trandem with health professinals.
  • America in the future will have a dual system -  one operating within the context of government government regulations and value-based outcomes and the other based on direct cash contracting of patients with doctors.
  • Political Aprodisiac -  Control of health care is a political aprodisiac .  A broad siocui saftey netw will always be necessay.
  • Governent Innovation  -  You cannot bottle or direct or crate innovation at the federal level,  Spontaenous imaginative individuals seeking better solutions form the bottom up is necessay.
  • Pure Ideologies   - Pure ideiologies, either liberal or conservative  do not usuall owrk.
  • Language of humanism - elegant language of humanism, spiced with straight talk, insprirtion, and humility is a necessary is essential for developing a workable system that does not break the national budget.
  • Limits of IT -  Algorihms and appas, no mater what their scope or ingenuity, will never replace or replace,human intellegence and imgination and ablility to cut to the chase.



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