INSIDE THE CURRENT ISSUE

January 2009

Fast Foreword

Spinning political healthcare
reform v. 2.5

Regardless of your political persuasion, you at least have to give President-elect Barack Obama props for his commitment to healthcare reform.

Mr. Obama made it an issue during the campaign, and rather than let it lapse into a D-list priority after winning the election as did Presidents Bush (both terms) and Clinton (second term), he demonstrated the seriousness of the issue with at minimum some dedicated rhetoric and a skeleton plan of attack before he’s even inaugurated.

Mr. Obama could be justified for sweeping healthcare reform under the rug as he must grapple with a faltering economy, government bailouts of the mismanaged banking/credit/finance and automotive industries, a multi-fronted "war on terrorism" and a host of energy- and education-related issues garnering media overexposure. Certainly his predecessors didn’t have so many distractions.

But while Mr. Obama may be cheered for his assertiveness, he may face questions in the coming year or two about the content of his healthcare reform plans, including his selection of former Sen. Tom Daschle as both Department of Health and Human Services secretary and director of the new White House Office of Health Reform.

Many media outlets may be giving Mr. Daschle the benefit of the doubt today, based on his recently published book about healthcare policy and system overhaul, but the goodwill may not last if substantive hope-inspired changes aren’t proposed and enacted within a reasonable time frame. Mr. Daschle’s initial plan to host a series of town hall meetings to gauge public opinions and generate awareness of the issues certainly raise eyebrows. After all, the Clintonian healthcare reform initiative and its ultimate collapse underwent intense dissection and scrutiny, and Mr. Daschle’s book required an extensive amount of research to produce – research that should have included a populist understanding of the issues. Hence, this process should be farther along than it is. Awareness and understanding of the issues inspired the recent electoral shift. Mr. Obama wants to "hit the ground running" on Inauguration Day. Town meetings that only rehash the obvious delay that strategy.

To give the healthcare reform movement some historical context, v.1 happened during the late 1970s to early 1980s, culminating with the implementation of diagnosis-related groups (DRGs) as a reimbursement mechanism and the arrival of managed care, seminal events in their own right as the balance of power shifted dramatically to payers from providers.

The next significant healthcare reform development, v. 2, arguably occurred in the early 1990s with the Clinton Administration’s drive for government-sponsored universal healthcare, led by then First Lady Hillary Clinton. While Mrs. Clinton and her Jackson Hole think tank seemingly overturned every rock and explored every hard place, it succeeded in heightening awareness of the issues and produced a gargantuan policy report, further illuminating the byzantine bureaucracy of government logic.

Nearly lock-step with v. 2, if not close on its heels, was v. 2.1., a shorter-lived "upgrade" spearheaded by the Clintons’ arch foe in the Republican-controlled Congress in 1994, then Speaker of the House Newt Gingrich. His "Contract with America," a thinly orchestrated paper response to the Clinton initiative, went virtually nowhere, meeting its untimely demise when Mr. Gingrich bounced himself out of office under a cloud of ethical lapses and political decision mishaps.

Rather than fade into history, however, Mr. Gingrich parlayed his political acumen and healthcare policy experience into high-visibility seats with a few prominent think tanks, including founding the Center for Health Transformation. Mr. Gingrich’s more cultural than political resurrection can be classified as v. 2.3, as he began to stump for the adoption and implementation of information technology in healthcare, even keynoting an AORN Congress a few years back.

But Mr. Gingrich’s notable efforts to push IT as a way to eliminate inefficient and wasteful practices in a top-heavy healthcare industry coincided with the Bush Administration’s promotion of healthcare IT, circa a national electronic health record fed by electronic medical/patient records, as v. 2.4. Mr. Bush appointed a national health "czar," who basically succeeded in raising awareness…yet again…before departing for the more lucrative private sector and leaving much of the legwork to implement "software-as-an-industry-saving-service" to a less-than-visible successor.

Mr. Obama and Mr. Daschle need to learn from the policy wheel-spinning of their Republican and Democratic predecessors. After 16 years of stalling, the American people want action – not more of the same.