Suzanne Elshult, http://hrnow.net Executive Yak, sponsors live round tables for senior marketing and human resources executives in the Seattle area and offers executive / professional coaching and virtual learning opportunities for leaders, business owners, consultants and coaches committed to growth and high performance.
I had a provocative discussion on healthcare reform with some 25 top HR executives in the Seattle area last week. Any doubts I had silently harbored about how meaningful this roundtable would be, evaporated almost instantly as the group started interacting in a meaningful way almost immediately. Some of the comments from long-standing members have ranged from : “fantastic session” to “the best HR Executive Forum we ever had.”
So, what did I walk away with? A sense that healthcare reform will happen. There is an expectation that something will land on Obama’s desk before the end of the year. We can save a LOT of money by addressing systemic problems such as overutilization and administrative waste (some say as much as 50%). A single payer plan is not possible in the US at this time – it’s too great of a clash with our culture of differentiation, choice and competition – one size fits all simply will not work here. Realistically a public/private option is most likely to fly. One of our member executives pointed out that in the 13 countries her company is doing business, the US is the only one with no government option, but in most other countries with a public option it is not comprehensive and employers still offer supplemental plans. What else? The expectation that we can cover everybody for everything is unrealistic. We have to decide what it is we can afford and what our priorities are. That is hard to do without it becoming deeply personal. Regardless of what happens employers will continue to play a big role.
Questions I Have
- Can we really save 50% of healthcare costs without doing a single thing ( some say we can achieve that level of savings by addressing things like overutilization, defensive medicine and administrative waste)? There are huge barriers to overcome including the fact that trial lawyers have 2/3rds of congress in their pocket (in part our litigious society is at fault and the expectation we have that any outcome that is less than perfect is unacceptable and reason to file suit). Doctors are being increasingly squeezed – paid less, expected to be more productive and thus see patients less – and trying to make up by finding new ways to make money (in-sourcing services, more tests etc…). Some say the individual practice model is dying and morphing into something different. As an industry, healthcare has lagged sorely behind in terms of investing in technology to reduce administrative waste.
- Will the US economy collapse if we fail to do something now. The weight of our current debt is staggering and healthcare reform may be an issue of national security. What happens if China stops buying our treasuries?
- Does it make sense that employers continue to play as big of a role in providing healthcare as they have in the past? The current model grew out of the depression. Are things different enough now to warrant a totally new and different model?
- How can we be successful long-term with healthcare reform if it does not decisively address the underlying issue of becoming less healthy as a society? In fact some reform seems to go against some of the inroads we have been making with wellness strategies in recent years.
- How can we better educate our citizens/employees to become more savvy consumers? We have not done a very good job in the past.
- Is it realistic to expect the average citizen to track healthcare reform and understand the implications for themselves and others when one single bill is more than 1000 pages (are you wonky enough to go on the internet and read it all?), and there is a lot of secrecy and machinations under the table in Washington DC? Newt Gingrich calls the legislative process “perverted “ (at least one thing he and I can agree on).
- Is fee for service medicine all over and going away? How do consortiums differ from managed care? Is our specialty-oriented way of providing care viable? Our specialty orientation is very unique to the United States.
- Why is dealing with healthcare so different from how we deal with education in this country? We all pay for public schools and then as a private citizen you have the choice to pay more for a private school?
- Can we afford to pay for everything? Probably not. The problem with the Washington State Basic Plan is that it is trying to cover too much. So, how do we decide what we can afford and what is important to us as a society? Does it ultimately boil down to what Keith Olberman said recently….it all becomes very personal when we start talking about death. It is really all an academic discussion until you or someone in your family gets sick.
- Some healthcare reform options provide employers with an opportunity to pay a penalty (for example 8%) if they stop providing healthcare? Is this a built-in incentive for employers to say “Great, I will write you a check?” Is this a way to give the public option a jump start? Is this good or bad?
Do you have answers to any of these questions or other questions you want to add? Reply to this post!!!
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This is a multi-tiered problem with no single solution. Models of universal health care also carry faults, but ring true to the principle that health care is not a commodity but a basic human right. American culture places great importance on “pulling oneself by their own bootstraps” and the free market economy concept, the idea of a more community driven and altruistic approach to health care is too extreme to expect all at once. My hope for current health reform is that it will act as a first step in bridging the gap – eventually the US health care system will find a happy medium but there will be many amendments to come.
These are excellent questions. Dr. Andrew Weil says that we will never get medical costs under control until we teach people how to stay healthy. I agree and also think that CONSUMER education is key. I just read a wonderful article in the Christian Science Monitor describing the strengths and weaknesses of health care approaches taken by several other countries. In Singapore they post costs of procedures and stays in various hospitals, which keep costs down. They do not, however, rate quality of care. Imagine if we did both!!!!!
The whole complementary/alternative medicine movement is a testament to the power of the consumer pocketbook. The federal government didn’t establish an office for this until it noticed that people were spending just as much out of pocket for this kind of care as for conventional care.