Embrace a basic truth about health care reform

The Supreme Court has spoken. The Affordable Care Act is upheld.  So what does this mean for those of us actually involved in health care?

First, there is a lot of work to do. The Court has reached its decision with regard to the legal issues; what remains are the challenges of improving the quality of care, lowering its cost, providing access to those who need the care, integrating technology into work flows and relationships, and developing the workforce that can deliver all of this.

We have an aging population. That is simply a fact. Baby boomers are entering their most health care-intensive years. This will tax our capabilities: all medical students are exposed to pediatric medicine, but not geriatric medicine which can be much more complicated as it often involves multiple ailments. It will challenge our capacity: this demographic reality will push costs upward and stretch already overburdened facilities, payers, and providers.  It will test our convictions: Will “choice” be sacrosanct if it pushes the system to the financial breaking point? Will end-of-life planning go from being derided as “death panels” to required prudence as the number of aged balloons? Will evidence-based medicine be able to stand when it goes against popular opinion of the vocal, voting senior set?

At the other end of the continuum, we are seeing increasing rates of obesity, asthma and other chronic conditions among our young people. Independent of the structure of the health care system, these children are going to need health care – perhaps for the rest of their lives. We have yet to understand the long-term impact on the health system and society at large. Once again, we will confront choices defined by our capabilities, capacity, and convictions.

We are in the midst of technological transformation. From electronic medical records to diagnostic smart phone apps, emerging technology is reshaping how patients, doctors, nurses, and insurers interact. Processes are being retooled. Standards and expectations are being reformulated. Work and patient-provider relationships are being recast throughout the system. And, as we well know, technology is far less static than the law: change will be constant.

What are we to do? First, we implore both the winners and losers in this case to lay down their ideological arms. Ideology rarely spawns true solutions to complex problems. Ideological positions stifle creativity, compromise, and collaboration. If the challenges to the system are to be met, the full range of stakeholders are going to need to be at the table and feel welcome to contribute their ideas, energy, and inspiration.

Second, relent on the desire to design a perfect system and focus on creating a system that can evolve and adapt. Populations change. Technology shifts. Business models advance. Conditions emerge and treatments follow.  In such a context, negotiation is the specialty that unites patients, clinicians, payers, policy makers, politicians and yes, even lawyers. The ability to engage in productive multi-dimensional problem-solving cannot be over-estimated as we move from a Court decision to operational reality where the health – and lives – of people are on the line.

Finally, embrace a basic truth about challenges as complex as health care reform: the place to start with the assumption that no one has all of the solution yet everyone has part of it. Even the people you demonized up until now.

Leonard J. Marcus is founding director and Barry C. Dorn is faculty for the Program for Health Care Negotiation and Conflict Resolution at the Harvard School of Public Health. Eric McNulty is Senior Associate for the program.  They are co-authors of the second edition of Renegotiating Health Care: Resolving Conflict to Build Collaboration (Jossey-Bass, 2011). 

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  • http://www.facebook.com/marc.frager Marc Frager

    Let us not forget that an ideal health care system allows patients to have choices, and is just not about decisions handed down from on high based on rulings from expert panels. Let us make sure we retain our individual freedom under any new health care system.

    • JPedersenB

      Thank you for saying that! A doctor’s “orders” should not mean that the patient has no other choice….

    • http://www.facebook.com/jonathan.marcus.ca Jonathan Marcus

      Let us also not forget that physicians and other health care workers should have choices as well. When they are dictated to from on high, they pass this on to the patients.

  • http://twitter.com/jlchasin Lauren Chasin

    Very well put. Change is inevitable, the challenge is whether we can embrace it and evolve, or let ideology stand in our way instead of use our principles and ideas to guide us through.

  • http://onhealthtech.blogspot.com Margalit Gur-Arie

    The place to start is here: http://jama.jamanetwork.com/article.aspx?articleid=1199158
    Always has been…..

  • http://twitter.com/chukwumaonyeije chukwumaonyeije

    Very well put. Solutions to complex problems never come from dogmatic positions.

  • Robert Bear

    I agree – well said. There is too much overblown rhetoric on this topic. Common sense commentaries such as this are refreshing.

  • http://www.facebook.com/spk.02052 Sean Kennedy

    ACA makes some big changes to how we pay for healthcare, but it really only attempts to set the stage for a bigger transformation that needs to come. Hopefully, we can now turn our collective attention to the fundamental problem of how to deliver the care people need and want in less resource intensive ways. The medical system has evolved over several decades but we tend to talk as though it is hard coded. We can make choices to change the delivery system and we should. Or to put it another way, Embrace a basic truth about health care reform: changing payment mechanisms won’t fix the cost problem on its own.

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