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Friday, September 12, 2008
Health Care Is a Rudderless Ship
By Dr. Jim Tryon
Health Care Reform Advocate
In a front page article on the stalled process of health care reform in New Mexico, Winthrop Quigley identified a number of special interest groups whose refusal to accede to some element of change in the health care system has kept the entire reform process from moving forward. The special interest groups he mentions include physicians, lawyers, insurance companies, hospitals, state bureaucrats, labor unions, policy advocates and employees.
The reason Quigley offers for their resistance is that they have a financial interest to protect. They all have the power to say “No” to change, but no- one in government has the power to make them say “Yes.” Indeed, trying to untangle the web of issues and interests in health care seems overwhelming, and I sympathize with Quigley's frustration.
In 2006 the aggregate cost of health care in New Mexico was just over $6 billion, about the same as the entire state budget. But, there is a primary problem that exists that, when seen, can provide a pathway to the solution. Although we refer to it as the health care “system,” it is a non-system. Can you imagine running a $6 billion dollar enterprise without a chief executive and a board of directors? Without a governance structure there is no way to coordinate the business of health care. Without an empowered governance structure, special interests will continue to rule and protect their individual turf, and profit, at the expense of the whole.
As a member of the Governor's Committee on Universal Coverage for New Mexicans, I introduced the concept of creating a Health Care Authority, based on the Federal Reserve model in which we would have a governing body, properly funded, to provide oversight and direction to the increasingly complex entity of Health Care. The idea was accepted by some, but co-opted and marginalized by the governor, and rejected by many legislators whose mantra became “Not another government bureaucracy!”
There seemed to be little or no thought given to the reality that several independent state-run health care programs already exist, each with separate administrations and funding — and without any central oversight to examine evidence-based outcomes.
I have been told that a health care authority isn't politically feasible, an intellectually weak comment usually offered as an indirect way of opposing change. There seems to be little recognition of the fact that more than 70 percent of New Mexico health care expenditures are public, not private. Whose minding the store?
Quigley pointed out that other countries are struggling with health care costs. Of course. The equation is the same for all of us. We have to balance the need to have universal coverage with the reality of finite resources. And without a health care agency properly empowered to understand the on-going dynamics of health care, and provide solid evidence for the services it offers we will continue to be a collection of lemmings heading for the cliff.
All hands should be aware that the concept of a health care authority is gaining traction now at the national level, and the need for governance is becoming more and more apparent. My advice to the public: observe the opponents to a health care governance structure and you will discover the special interests who are threatened.
The health care problem reminds me of a piece of wisdom from an obscure, esoteric literary work that said without a clear-cut, positive goal set at the outset, situations just seem to happen, making understanding doubtful and evaluation impossible.
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