05 August 2009

National Healthcare Reform Leadership

A new national healthcare system is in the works, or at least a modified one. Which is good, because no matter how you slice it the country needs to do something about steadily increasing healthcare costs, says the CBO.

If rising healthcare costs were a steamroller. . .

In BusinessWeek, Nikos Mourkogiannis proposes that the new system should focus on cutting costs. He also says that, while that is a fairly obvious consensus view, actually implementing it will require prodigious acts of leadership. The general idea is to create a system that ensures the average person will have a minimum level of benefits.

As Mourkogiannis points out, the new healthcare system will not be able to do everything for everyone, it will have to make triage decisions which first reduce costs (and do everything else second). From the White House:
President Obama is committed to working with Congress to pass comprehensive health reform in his first year in order to control rising health care costs, guarantee choice of doctor, and assure high-quality, affordable health care for all Americans.
The fun thing about mission statements is that they often utilize a lot of commas. Giving commas to a bureaucrat is the linguistic equivalent of giving a credit card to a teenager. All sorts of commitments are made with little consideration given to whether or not they can all be delivered. The term "high-quality" has a lot more wiggle-room than "affordable," and the situation demands the focus be on "affordable" anyway, so "high-quality" is really only in there to attempt to placate fears that the healthcare storm troopers are going to drag you off to the crematorium when you reach 65.
Your grandpa ran off to join the circus. Here's his replacement.

High-quality will have to be secondary to low cost. The only reason we need healthcare reform is that our current approach will bankrupt us. So, at a minimum, we have to do the same thing only cheaper. Improving quality would be nice, but it is not the primary driver; cost is.

Now, try explaining that to the people who will cost too much to take care of.

This healthcare reform situation is a good example of a situation that demands attention be paid to systems, innovation and leadership. The system is monstrously complex, implementing it won't work without some innovations that no one's thought of yet, and even then the leadership challenge is pretty much guaranteed to be beyond anyone's capabilities. We (Americans) are okay with the idea that the system can't take care of everyone. We are not okay with the idea that the system will officially not be taking care of everyone because they are officially on the wrong side of the cost/benefit analysis.

That being assumed, what sort of leadership approaches have the best chance of getting people to at least let the necessary changes happen, if not get people excited about the changes?

  • "We are working hard for you, but someone/thing else is working against us." Whoever gets saddled with the job of representing healthcare reform can try casting themselves as the plucky, unquestionably-good-hearted hero valiantly struggling against an evil menace. The menace could be immigrants flooding our emergency rooms, greedy HMOs, or just the vast scale of the problem.
  • "We all know more than you and we say this is a good idea/working." Several large stakeholders in the healthcare marketplace, like the pharm-companies and AARP, have already expressed support for healthcare reform. It could be possible to present a unified front that overwhelms any attempt to claim it's a bad idea.
  • "Every alternative is worse, especially doing nothing." Proponents of healthcare reform, like me, have pretty much started here anway. This approach assumes that this will remain the primary tool moving forwards. It could be expanded upon by occasionally adding a new description of just how bad the future will/could get if things aren't done in a particular way.
  • "I was worried, but now I see there's nothing to worry about." Instead of the leaders speaking, they could get average Joes and Janes to speak for them. That way the people who need to be convinced could see people just like them being convinced, rather than Ivy-league, smooth-talking socialist puppets trying to be convincing.

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