I marvel at the lack of understanding of the timetable for and potential impacts of federal health care reform efforts by educated, interested and engaged people crossing my path. With 25 plus years of health care administration and policy experience, I have learned (often the hard way) that all health care is state and local. States license clinical professionals and facilities, register insurance companies, create unfunded mandates for insurance coverage, decide how to distribute Medicaid coverage to beneficiaries, and create other incentives for health care facilities to grow their services or close their doors. Local jurisdictions engage in an ongoing debate about resources to support indigent persons in the community through a variety of fiscal incentives. Most hospitals and medical groups serve very small geographic areas. Yet many of the people I speak with act as though the proposed federal health care reform will have imminent and dramatic impact on their lives.
As I returned from CSPO CNS-All Hands last week I was fortunate to sit next to a Georgia resident returning home to take care of her aging mother in a rural part of the state. My seatmate was a retired chemical engineer and her husband spent 30 years working in international financial affairs. We talked for three plus hours from take off to landing about U.S. health care reform, especially as it impacts retirees like her, her husband and her mother, who has significant health issues and the will to continue living independently in the home she has owned for over 50 years. My seatmate was amazed to learn that federal health care reform policy affects primarily financial incentives (it is essentially tax or IRS legislation) and that it is up to the federal regulatory agencies and then state regulatory agencies to implement the final bill to affect financing and delivery of health care. It will be years before individuals feel the impact of any health care legislation that might pass. Certain challenges of the constitutionality of the current federal legislation proposals will delay implementation even more. This is not unlike prior federal health policy initiatives that took interesting turns in regulation, had varied impacts on state and local health care delivery systems and then resulted in unexpected consequences for individuals.
This experience and others make me believe that the current push back on health care reform is more the result of lack of understanding of broken parts of the system and how the system evolved over the last 50 years than rejection of the need for reform. The awakening of the American public on health care policy and the development of health sciences is refreshing and I look forward to the ongoing debate. My recommendation to interested parties is to study the federal legislation but then think state and local policy, including the policy implementation timetable, before deciding impact on themselves or their family.
1) a frank understanding of the norms and expectations we have about health care. For one - we have all been lead to believe that the MORE healthcare we receive the better and the MORE technical and expensive the healthcare we receive is the higher its quality. The outrageous marketing promises of technical medicine - that they can fix every ill, twing, and ache - have led to unreasonable demands for care. This despite any evidence that most of us are doing better.
2) There is no way I can understand or should want to understand every arcane aspect of the legistative process at the federal, state. and local level. I elect representatives, who do know the systems, to understand for me. Most of us in the real world have enough to do -- and basically - when something looks bad, smells bad, and tastes bad - and NO ONE seems to be able to explain in plain language why it is GOOD -- it seems to me a normal and healthy reaction to say WHOA, let's re-evaluate what is happening.
I beleive everyone in this country wants better and different policies that make medical care (nothing about the current debate is actually about health) accessible, affordable,portable, and equitable. Demonizing those who are leery of rapid changes and fear unintended consequences is simply wrong.
However, I would argue that many educated/interested/engaged people are ignorant of the details of many (most?) important policy issues. I spent the better part of my week learning about energy policy, and in some respects I feel more confused about the policy solution than when I started a few years ago. So, how informed is informed enough? How can people better inform themselves and what do they do once they're informed? How can we do a better job of democratizing the healthcare debate?