On more than one occasion, I've been asked what I think of the Obama and McCain healthcare reform proposals. What I always say, as I have in previous election cycles, is that I haven't bothered to read them. Why? I just don't think they make that big of a difference. Truthfully, I'd say that about the vast majority of what's going on in the federal legislature where healthcare is concerned. (States, on the other hand, are clearly having more of an impact, but that's a subject for a different column.)
Of course, I do realize that government planners have a meaningful role to play in the system, as custodians of public health programs, funders of research and not-for-profit outreach and payors for benefit programs. But I'm skeptical that even the immensely powerful CMS can make significant changes to health system dynamics. So you can rest assured that I doubt either candidate is going to stand our industry on its head, even if they enjoy the support of Congress. There's just too many moving parts involved.
Am I happy about this? Actually, I'm not. Because of the unique mix of public and private mechanisms we have in place in our system, we are joined rather closely to the rhythms of government, which undercuts our ability to create a purely market-driven solution. Under those circumstances, it would be so convenient if a President Obama or McCain could stand up, propose nifty solutions to painful health system issues, wave their hand and say "make it so."
The truth is, we're going to have to wobble on for quite some time as we are before someone tames the unwieldy public-private mix we've got. Right now, providers may hate CMS, but most are in a tight embrace with Medicare nonetheless. Public health continues to plug holes in our system that might push it to the breaking point. NIH funds research that the private sector might not, which takes pressure off the pharmas. And so on. Public and private forces are what a psychologist would call "enmeshed" (and that's not a compliment).
What do you think, folks? Is this mix as unruly as all that? Can our health system continue to move along as a public-private hybrid, or is that the least of our worries? I'd love to get your thoughts. - Anne