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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