Reform Depends Upon Some Unpleasant Decisions
“Our time of standing pat, of protecting narrow interests and putting off unpleasant decisions — that time has surely passed.” – President Obama
Among diverse listeners, this excerpt from President Obama’s inaugural address doubtless evoked different social, economic and political calls to action. For me, the words struck a chord in the context of our country’s long-standing ambivalence toward fundamental health system change.
Here are just a few examples of the “unpleasant decisions” that will accompany efforts to cover more people, rein in health spending, and use new treatments and technology more effectively:
• In order to improve patients’ access to primary care providers, should they be paid more while specialists are paid less?
• Where multiple prescriptions/treatments are effective for most (but not all) individuals, should people be required to try less costly approaches before moving on to more expensive ones?
• Should young, relatively healthy Americans pay more than they do today, in order to subsidize the old and relatively sick?
• Among those who have insurance, should we impose limits on choice of providers and covered treatments – particularly those shown to cost more and/or be less effective – in order to contain overall spending?
Affording health coverage for more people involves trade-offs. (You can explore these trade-offs and answer a few questions to identify your preferences here.) No matter how successful in the long term, a broader health reform agenda – changing the way care is paid for and delivered, and increasing our commitment to prevention and wellness – will still create short-term winners and losers with respect to cost, choice, and autonomy.
The recent announcement that health industry groups would voluntarily reduce spending by $2 trillion over the coming decade sounds like – and may prove to be – progress. But as they have for decades, such commitments may prove fleeting when confronted with specific legislative proposals. In this context, another commentator’s admonition to “Trust but Verify” seems well-placed.
Are we ready for “unpleasant decisions” in health care? It’s much easier to get disparate stakeholders to agree that the current system needs reform than to agree on who should pay more or be obligated to behave differently to change it. To me, a sign of progress would be open political discourse about specific sacrifices by some in order to assure more appropriate, accessible and affordable care and coverage for all.
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