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Searching for Health Reform In All The Wrong Places

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July 17, 2009

Over the past few weeks, I have had a serious case of "news junkyitis" for everything I could find out about healthcare reform as Congress and the Obama administration debate what to do for our country's healthcare crisis. I'm trying to be hopeful that real reform will happen--that we will make some substantial changes to how we conceive of, deliver, and pay for healthcare in America--but I am starting to lose faith. And I'm growing desperate enough to wade into the blogosphere for the first time in my life. Thus, I hope to use this space to share ideas, ask questions, learn from others, and debate the very real and very complex issues that face us all as we wear the multiple hats of patients, family caregivers, coworkers, and voters who want a better way to do healthcare in America.

I come to this blog wearing many different hats myself—for example, as a patient who routinely goes through the frustrations of repeated labwork, scheduling appointments too many months away, dealing with too many specialists who don’t talk to one another, managing multiple chronic conditions, and taking far too many medications—all while trying to make myself exercise more and lose weight (which I am currently failing at miserably). I’m a patient advocate for a few dozen folks each year who need some assistance with everything from researching their cancer treatment options online to having someone drive and hold their hand at a scary test they have to go through. I’m also a concerned son who is lucky enough to have two retired parents who are in pretty good health but live far enough away on the East Coast to make me worry about what will happen as they get older.

Yes, I have an important-sounding title at Intel—the current one is something like “Global Director of Health Innovation, Strategy, and Policy”—but I’m really just a proud and passionate social scientist in the Digital Health Group, who started our research programs 10 years ago to explore personal health technologies for disease management, independent living, and wellness at home. I’m a researcher who has spent the past 17 years studying doctor-patient interaction, telehealth technologies, and doing fieldwork in homes and hospitals to think about how to deliver care differently. And I’m a proud co-founder and member of the Center for Aging Services Technologies, or CAST, in Washington, D.C. which is a great coalition of leaders who want to reinvent long term care in this country with more options about how people live, work, and play as they age.

All that being said, I make no claims to being an expert on all things healthcare (and I’ve never met one, because “healthcare” is so complex that no one person is an expert on all of it). My life experiences both inform and obscure my perceptions of the world and of this reform debate. As I mentioned at the beginning of this blog, my faith in healthcare reform is being sorely tested by the following top-of-mind concerns:

1) Prematurely Rushing Towards “Mission Accomplished”: I fear we’re rushing towards a healthcare reform bill that doesn’t address the fundamental changes we need in care delivery, payment, coverage, incentives, tort reform, social responsibility, and infrastructure. To declare “mission accomplished” on healthcare reform prematurely—without really making fundamental changes—would have terrible consequences for our economy and push out the hard problems of reform for another decade or more. We can’t defer these challenges again to another Administration and generation. We have to use this historic moment to really set a new vision and infrastructure for doing healthcare differently in America, that is more focused on health, prevention, behavior change, and personalizing care to whatever settings and cultural contexts drive the best outcomes. Real reform requires a going-to-the-moon kind of engagement of public attention and investments—and a new social covenant for how we will operate as citizens, consumers, patients, employees, and family members. If that means taking a bit longer on health reform than we thought, then so be it. It is the largest, most complex part of our economy, after all.

2) Ignoring Delivery and Payment Reform: Congress and the media are so focused on “coverage”—and showing that they have a way to cover the uninsured (which is fundamentally important!)—that they have skimmed over the much-needed reforms in delivery and payment that will reduce the costs enough to increase quality and access for everyone. If all we do is suddenly bring the uninsured into an already overburdened, inefficient, and reactive delivery system, then we’re simply bankrupting ourselves faster and putting even more stress on already shaky fault lines. Let’s not just add more people to the waiting rooms, more appointments to the doctor’s over-scheduled roster, and more costs to the payors. Let’s figure out how to drive the kind of preventive, proactive, and personalized healthcare system that treats people at home as much as possible, that pays clinicians for successfully managing the care of their patients instead of managing the medical bureaucracy, and that delivers care in a wide range of locations and contexts (in home, in community clinics, virtually via telehealth technologies) instead of using our most expensive hospital resources to treat the epidemic of chronic disease and non-urgent needs.

3) Asking Everyone Else to Change and Sacrifice, But Not Me: As I struggle to find an affordable hotel room in D.C. next week where everyone (me included) is descending upon Congress to try to have their voices heard in this debate, I’m struck by the “not me” mentality that I think will kill healthcare reform if we don’t change our perspectives. I hear each interest group or constituency holding forth about how critical it is that no one change their situation, but that all the other aspects of healthcare need reform. If we all simply come in trying to protect our own turf while asking everyone else to pay the price for healthcare reform, then we are doomed to failure. We—again, me included—ought to be stepping back from our particularly narrow points of view as activists, lobbyists, or representatives of a specific issue or group to wear a broader hat: as a patient who will need care from this system we are reforming. So if only for a moment, we need to stop being Politicians, Lawyers, Researchers, Employers, Tax Payors, Lobbyists, Reporters, Doctors, Nurses, Payors, and so on…and be a person who wants to rely upon this healthcare system for care, possibly even to save our life. And we ought to use this moment of reform to design a care paradigm that we would want to use and pay for ourselves. Then, when we put those other hats back on, we have to be prepared to change our behaviors, expectations, and culture—and many of us will literally need to pay more money somehow—to come up with solutions for our 21st century healthcare needs. If the Providers and Payors and Patients and Lawyers and Employers are each unwilling or afraid to change the way we do things—and if no one is willing to sacrifice—then real reform is dead already. If we’re not willing to look inwardly to ask what each of us—wearing all of our various hats—is prepared to do for our country, then we’re looking for health reform in all the wrong places.

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