Why Health Care Reform May Fail Again

With the debate over health care reform in the White House, both Houses of Congress, and in the public at large becoming more vigorous, I am curious about the lessons to be learned from the 1994 debacle—the nonpolitical lessons. I often wonder: What is the single most significant factor that led to the failure in 1994, and how can we, as a nation, work to address it?

Recently, I came across a perspective comparing the public’s current views about health care reform with those of 1994.1 There is a striking similarity. In both instances, although an overwhelming majority of Americans want health care reform, only about 40% support the Obama/Congressional plan or supported the Clinton plan in 1994. In both cases, the vast majority feels that neither will the quality of health care improve nor will the cost of health care decrease as a result of these reforms. On the surface, it seems like a poor job of marketing the package to consumers. But could there be something more?)

One simple fact that has remained essentially unchanged and gone unnoticed in the past 15 years is the low levels of functional health literacy and overall literacy skills among US adults.2 What this means is that a large number of Americans are unable to integrate 2 or more pieces of related information with reliable accuracy and consistency, especially in health context.

Therefore, any government administrator or elected official who tries to convince the majority of their constituents of the validity of even a sound health reform agenda needs to ensure that those folks comprehend the message being delivered. Or else a majority of Americans will not be able to make good decisions and, as a result, will remain hostage to the agendas of various groups.

So what’s the solution? There should be a concerted effort by all stakeholders to ensure that the public has the tools required to comprehend the basic principles of the proposed health care reform legislation and then debate it, not vice versa. In other words, we all need to do some homework! If not, there is a good chance that the well-meaning health care reform agenda will be derailed, again.

References

1. Blendo RJ, Benson JM. The American Public and the Next Phase of the Health Care Reform Debate. N Engl J Med. published at www.nejm.org November 4, 2009 (10.1056/NEJMp0906394). Perspective.
2. http://www.ncsall.net/fileadmin/resources/teach/environ_resources.pdf

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  • While I do not debate all the reasons behind our less than perfect healthcare system stated here and many others as well, we have known about these for a while and therefore most of these do not come as a surprise to me or many others. What is unacceptable is that while we continue to practice in the field, most of us do not tend to be activists. In other words, we have not done much to educate our patients, staff or the general public on what are the real challenges that lie in reforming the healthcare system. Think about it. How many forums have you personally held or attended to learn about and advocate your point of view?


    As a result, political gurus have taken it over from us, given various issues a political discoloration and are now debating it as a 'democrat' or a 'republican' issue, often forgetting the 'human' aspect of it. How did we get here? We physicians need to be asking how we can better educate the public so that the masses get on the side of healthcare reform - whatever shape it may take, whenever it may occur, not against it. When we have engaged the public at large (and I emphasize we, not the politicians), public good will happen. Until then, it's just a political game with the odds of something resultant good happening equal to those of gambling in a casino.

    ragupta, 3 years ago | Flag

  • Sorry rgupta, I don't buy it. Some of the real reasons the healthcare reform effort is doomed to failure are:


    1. Attempting massive system change without attention to the infrastructure. The IOM studies have made it abundantly clear that our Emergency Departments, EMS and trauma systems are dysfunctional and severely broken. Clearly stripping more funds from Medicare will make this situation worse. An incremental reform approach, with objective evaluation and correction as necessary is the approach used by many other systems.


    2. Denial of the need for serious tort reform. Just look at where the tort lawyers' lobby spends its dollars. 


    3. The iron triangle of healthcare: i.e cost, access and quality, is not subject to political doublespeak. It's simply unrealistic to attempt to address one or two of these factors and not expect a decrement in the third.


    4. Total denial of the accelerating nursing shortage. 


    5. Continued linkage of healthcare to employment. This linkage is an artifact of WWII price controls and is archaic, but those who benefit from it are vigorously lobbying for its continuance.


    6. Lack of buy-in by the deliverers of healthcare, and I do not mean the hospitals or third-party payers. Physicians and nurses have had little meaningful input in this process. BTW, the AMA is taking enormous heat from the fraction of American physicians it represents, for its positioning on reform.

    bajadoc, 3 years ago | Flag

  • Folish you, we want ObamaCare to fail.  It decreases quality and increases cost.  Effective private sector solutions include tort reform, interstate purchase of insurance,  individual mandates for insurance, and open transparent physician and hospital pricing.

    The Good Doctor, 3 years ago | Flag

  • Why try to intellectualize this problem----this is America---MONEY will determine the outcome of this debate--not what WE think or the public thinks----MONEY !!!  I'm sorry but I'm a product of the 60's--nothing changed....MONEY DICTATES EVERYTHING IN THIS COUNTRY. I try to do the best I can each day-----Policy debate is totally a waste of time> Even M.D's worship "OUR GOD"   =  MONEY

    jimimd, 3 years ago | Flag

  • After reading the eloquent writing by Dr. R. Gupta I cringe at his thesis that the problem is that the people do not understand what the administration is trying to "sell".


    The problem is that they cannot sell it by speaking the truth and they keep spewing the same talking points over and over, many of which the people know to be unrealistic or flat out lies.


    People are engaged at an unprecedented level and we just do not want the government intrusion and control of the Healthcare system and over 1/6 of the Nation's economy.


    In addition to that, the Federal Government does not have any contitutional authority to issue any such mandates on the American people.


    It is not a problem of the people not understanding the issues, it is simply a problem of the people REJECTING the proposed "solutions"

    rdymdfacs, 3 years ago | Flag

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