The Benefit of the Doubt
As I listened to President Obama's speech as he went before the American Medical Association House of Delegates on Monday, I sensed that the tone of the event was one of mutual respect. While not a campaign trail love-fest by any stretch of the imagination, the event could have been much more contentious for Obama. He asked for and received the benefit of the doubt from these representatives of the nation's doctors. The President acknowledged their fear of change and emphasized his desire to fix what's wrong while building upon what works, such as electronic health records, prevention, wellness incentives and evidence-based medicine. Proposed changes to physician compensation, such as bundled payments and pay-for-performance, were politely received. Less well-received was the president's insistence there not be caps for medical malpractice awards, a long-sought goal of the AMA.
The President spent much energy driving home the argument for a public insurance option and reassurances that such an option was not a single-payer "Trojan Horse." He is asking for the benefit of the doubt.
Conspicuously absent was any discussion of taxing employer-sponsored health-care benefits. And the issue of individual or employer mandates was hardly touched upon. How, then, to pay for this anticipated 10-year, one trillion dollar investment in re-shaping the U.S. health-care system? A return to more modest Reagan-era tax deductions for the nation's wealthiest citizens coupled with a reduction in Medicare payments. He is asking for the benefit of the doubt.
It was a long speech that required a lot of active listening to appreciate fully. Toward the end it struck me: re-shaping health care is a BIG JOB. Health care, after all, has a lot of moving parts. What's broken about health care is that the parts aren't moving in sync. The worst thing we can do is to pay more for the same disjointed services we are buying now. Conceptually, I like to point out to folks that what we need to be driving toward is health care payment reform separate from, but enmeshed with, health-care delivery transformation. Even after we shrink it to 10 percent of the GDP, health care will remain an enormous, vibrant sector of the economy. To the extent that they keep working toward this end-state, the President and Congress deserve the benefit of the doubt.
Those of us working in the private sector to improve health and health-care delivery, control costs and improve the experience of care ask for the benefit of the doubt in return: Allow us to continue to expand our successful efforts to transform health care without changing the playing field so much that we are unable to continue.
Now repeat after me, "The public option is my friend..."
Posted by: lensch | June 19, 2009 4:42 PM
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