OBSERVATIONS - december 17, 2008
Health Reform: The Irresistible Pull of the Status Quo
In the immediate aftermath of the historic election of Barack Obama, there is some renewed optimism in the health policy community that maybe, this time, we will get to comprehensive health reform in the United States…perhaps not in the first 100 days, but maybe in four years. Indeed, there has been a recent flurry of comprehensive health reform proposals from Congressional leaders, industry groups and health policy thinkers, all jockeying for their proposal to be the one upon which the nation will build.
This seems like as good a time as any to remind ourselves of one of the pitfalls of the past 50 years of debate about comprehensive health reform: with multiple competing proposals being put forward by various parties, hardly anyone can expect to get his first choice…and everyone’s second choice is, unfortunately, the status quo. That’s how we get stuck with no change, year after year after decade.
This point was brought home explicitly at a recent roundtable discussion for Congressional staffers, cosponsored by the non-partisan
Alliance for Health Reform and the Kaiser Permanente Institute for Health Policy. The objective of the roundtable was to identify the successes and failures of California’s 2007 effort to enact health reform and consider how they might apply to health reform efforts at the federal level.
At this meeting, a number of stakeholders from the California process shared their thoughts about what they would do differently, if they had to do it all over again. One of the most common themes was the difficulty of building stable coalitions that can withstand the irresistible pull of the status quo. One veteran of the California debate noted that while many stakeholders support health reform, that support is based on narrow self-interests. That kind of support can vanish with the insertion or elimination of a single phrase from a proposed bill.
Instead, what is needed if health reform is to succeed is a measured approach to crafting a viable “second choice” that includes some pain and some gain for all stakeholders. However, this must be done in an incremental manner. Some observers believe that California’s efforts eventually failed because they tried to take on all opponents at once, thereby spreading the pain evenly. This sounded good in theory, but it may have backfired, as spreading the pain creates an alliance of the pained (according to one California stakeholder). On the contrary, as noted by roundtable participants with experience in the Massachusetts effort, the motto of reform in that state was “one opponent at a time.” This approach to working and compromising with the traditional opponents to some of the more thorny aspects of health reform (individual mandates, anyone?) resulted in a strong coalition in Massachusetts with enough common interests to craft a second choice that was, ultimately, better than the status quo.
So, the lesson here for all the would-be health-reformers who think they may see a light at the end of the tunnel? Take a deep breath. Go slow. Twenty months wasn’t long enough for California to get it done, so the nation will likely need even longer than that. Don’t give up too soon, and remind the public every day of why the status quo should be everyone’s last choice.
-Laura Tollen, MPH, Senior Policy Consultant, KP IHP
|
|
About
