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Chastened and More Sober, Harry and Louise Return

On Tuesday, Ron Pollack of Families USA led a call with bloggers — unfortunately, I couldn’t be on it — to discuss  Harry and Louise Return — the new health reform campaign sponsored by five prominent organizations: the American Cancer Society’s Cancer Action Network (ASC CAN), the American Hospital Association (AHA), the Catholic Health Association (ACHA), Families USA and the National Federation of Independent Business (NFIB).

The common goal of these collaborators is to get the next President and Congress to focus on
meaningful health care solutions. Beyond that – and of course all those experienced with the
policy-based reform process are aware of this – the motivations and
objectives of the participating organizations diverge. To get an idea
of the degree of their differences, look at the ASC CAN, Families USA and NFIB sites.

The first three groups are provider organizations. Naturally,
they’re concerned that money is evaporating for their services, and
they want to make sure they’ll get paid for any services they provide.

Families USA is an idealistic consumer advocacy organization that
believes the US should provide universal coverage because it’s the right
thing to do. (They tend to pay less attention to the structural
problems in health care that have created runaway cost.) While its an
admirable perspective, it also willfully ignores the fact that Congress
hasn’t passed any major social-justice-based laws for more than 40
years, and that as long as special interests continue to be allowed to
exchange financial contributions for influence over policy, it is
unlikely we will return to policy in the common interest.

It’s the fifth organization that’s interesting and unexpected. The
National Federation of Independent Business is the generally
conservative association representing small business. Here they join
with past adversaries, though NFIB’s mantras – affordable, stable
coverage with choice guided by knowledge of price and performance – are
at odds with some of their current pals.

The ad itself has a winning earnestness. The new one is above, and here is the one from the Clinton period. Like the country, now chastened
and more sober after its indulgence in patriotic zeal during the early
Bush years, Harry and Louise, older and wiser, aren’t so cavalier about
Congress making decisions without their input. The health care crisis
is all around and they need help. The punchline has Louise, with
heartfelt concern (against a plaintive musical score), saying, "Whoever
the next President is, health care should be at the top of his agenda,
bringing everyone to the table, and make it happen!"

It seems so straightforward! When I was working day-to-day on national
health care reform people would call to tell me what needs to happen.
As it turns out, knowing what needs to be done isn’t the hard part.
Most everyone inside and outside of health care who’s thought about it
even a little knows most of those answers.

No, the hard part is making it happen within a policy framework that’s
controlled by money and power. Displacing the status quo isn’t easy at
all. And as it turns out, its pretty clear that, while each
organization at this table dearly wants reform, they each, like all of us,
want it on THEIR terms.

I attended and blogged Family USA’s big meeting some months ago in DC. It had a range of terrific speakers, but the politicians among them —
Ms. Pelosi included — pretty much told them what they wanted to hear,
that health care reform can happen if people like them just stand up
for it. Feeling empowered, the audience LOVED that message. It didn’t
particularly matter that it wasn’t true.

The truth is that unless the nation’s most influential power brokers
mobilize to make changes in policy, it’s not likely to happen.
Consumers certainly aren’t galvanized around any specific health care
reform agenda or project that I’m aware of, so they don’t have a
significant power base on this issue. The good news is that a range of
non-health care Fortune organizations ARE working, quietly but
forcefully, on the problem, through the Patient Centered Primary Care Collaborative and other efforts.

More on that soon.

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10 replies »

  1. Paul,
    While I wouldn’t even think of besmirching the good name and work of the ACS, it is hardly pure as Caesar’s wife. It does accept very substantial support from firms that develop and market products for the extremely lucrative oncology community. As someone who is in the thick of what transpires in the cancer economy, I’m sure you’re aware that rebates and other unsavory tactics have made cancer care, and community oncology particularly, into one of the most conflicted areas of medicine. I’ve written about this problem a great deal – see http://www.communityoncology.net/journal/articles/0406367.pdf.
    Now none of this negates your assertion that ACS CAN is very concerned that patients have access to appropriate care. No one disputes that cancer is a horribly cruel disease, and that all cancer patients should have unfettered access to the advances that are available and are proven.
    That said, your protests would be a lot more convincing if ASC weren’t so beholden to so many organizations that thrive off the diagnostics and treatments – proven and not, and appropriate and not – paid for by public and private health plans on behalf of those afflicted with cancer.

  2. Brian. Interesting take and you make some good points. However, one thing I would like to make note of. You wrote:
    “To get an idea of the degree of their differences, look at the ASC CAN, Families USA and NFIB sites.
    The first three groups are provider organizations. Naturally, they’re concerned that money is evaporating for their services, and they want to make sure they’ll get paid for any services they provide.”
    Perhaps I’m reading it wrong. Are you implying the American Cancer Society or the American Cancer Society Cancer Action Network are involved with access to care because we are worried about “getting paid” for the services we provide? If so, this isn’t accurate.
    The government doesn’t pay for the services the American Cancer Society provides to cancer patients. The ACS is funded through its donors, not government grants. Same goes for ACS’ cancer research program. Government money can’t play into it – because there is no government money involved.
    When the American Cancer Society says its concerned about lack of health care being a barrier to surviving cancer, its because that’s what the data tells us. It’s not code for “we need more funding.”
    Our overall mission is to fight cancer. We need health care reforms to continue to continue the fight against cancer in a meaningful way. What good is the best treatment if no one can afford to take it?
    So our goal with this effort is to try to get as many people as possible in the general public to realize there are significant flaws in our current health care system.
    Thanks,
    Paul at the American Cancer Society

  3. Its amazing that Harry and Louise have aged incredibly well over the past 15 years. Maybe it would have been more useful for them to share their health/lifestyle tips instead of the generic platitudes of this commercial.

  4. Brian–
    What’s remarkable is how you and I often seem to be writing on the same topic at exactly the same time.
    And, as usual there is a weird overlap in what we are saying as well as notable disagreement.
    Yesterday, I posted a piece about “Health Care Reform,
    Interest Groups and the “Collective Good.” (See http://www.healthbeatblog.org)
    I was responding to Nicholas Lemann’s piece in The New Yorker where he suggests that there is no such thing as “the collective good” or “the common good” and that policy can only emerge from a battle among interest groups, each fighting to protect its own turf.
    I suggested that when it comes to health care reform, there is a collective or common good: the interests of the patient. Someday, we will all be patients looking for high quality, affordable care. And none of us knows whether we will be one of patients who faces a $3 million bill that only a fraction of the population can afford. This is why we must pool our unknown risks in a program founded on a belief in the “collective good.”
    I also argue that we should not invite every interest group to the table. Some interests groups have too much power (thanks to campaign contributions.)
    If we recognize the true goal of health care reform: “the collective or public good” then we should realize that, if given a seat at the table,lobbyists representing Pharma, Device-Makers, the AHA etc. will trump the public interest every time.
    We haven’t passed meaningful social legislation in decades because those interest groups have grown stronger–and as they compete with each other, they often create gridlock.
    Most Americans have wanted universal health care since the late 1940s. The reason we don’t have it is because we have accepted the notion that public policy is something that can arise only through “deal-making” among competing self-interested parties.
    We need collaboration–not competition–among groups that have just one goal: higher-quality, sustainable health care for everyone. That means containing costs. For-profit businesses in the health care industry want to see health care spending grow, so that their earnings can grow.
    If other (non-health care) businesses are primarily
    interested in public health–i.e. the health of the nation–they may bring something useful to the discussion. But we have to be wary.
    For-profit corporations have a hard time looking beyond their own monetary interests to the moral interest–the policy that is simply right on the merits.
    By contrast, I think that most (though not all) physicians and public health experts do put the patients’ intersts first. And this is why I would like to see them unite with patients–and help educate patients– so that more of us understand the goal: higher quality, egalitarian and affordable health care for all. Everyone needs to realize that higher quality and lower costs go hand in hand.

  5. OK, I want at that table. Here’s one insiders voice about that “devil in the details” of health care reform.
    For years, I set up and managed the physician entities, and wrote the business plans, that afforded coordinated and occasionally strategically aligned contracting between hospitals, their parent systems, physicians and the payor community. In all cases we attempted to consolidate provider assets aggressively within FTC/DOJ safe harbors, in order to build leverage to extract best price and terms from the payors on a discounted (non risk) fee for services basis. In others, we assumed partial or global risk for the benefit plans sold into the market place. This included private label options as well.
    Unless we worked with an established group practice with both a networked geographic presence in the target market(s), and a commitment to coordinated, peer reviewed (best practice, evidence based) care, we worked with our medical staff via IPAs, their “group practice without walls” equivalents, or even worse, hospital sponsored physician ownership vehicles.
    During this drama, I have witnessed over and over again, and aggressively counseled against, several high profile strategic misadventures by major national and regional systems. I’ll cite three only: AMI’s strategic blunder to launch AMICARE; HealthTrust Houston Region’s Super PHO modeled on a physician employment vehicle, diluted by a practice management portfolio, vs. an exclusive focus on strategic payor contracting; and finally, Texas Health Resources’, launch and divestiture, of the Wellspan Healthcare Network, saddled by the weight of the Harris Methodist Health Plan (now Pacificare/United), vs. the generic “payor neutral” platform that “fit” the market.
    There are many more. AMI was not the only one who was seduced by “big 6” experts into rolling out their own insurance product platform. HCA, NME, VHA and others ALL took the bait.
    Just add up the “one time charges” for discontinued operations incurred as virtually all of the players repositioned themselves into their “core business” aka operating hospitals; I am not even bringing up the subject of Physician Practice Management Companies (PPMC) and their 10 year run from Wall Steet to Main Street, remember MedPartners, PhyCor, FPA, and their many wanna be’s? How much equity was destroyed (extracted from the public trust) during this ponzi scheme/ostensible viable business model run? Did Merrill, Goldman, Bear Stearns, et al, return any of their investment banking fees? Was the “public” served?
    So where is the equity here? While I previously participated in the terms of what would be sold into the marketplace as “managed” health plans, I now am one of the 47 million uninsured. As a boomer, though in good health (I live an active life in San Diego, don’t drink or smoke and surf regularly), yet I am a “poor risk” to any potential underwriter of my expected health care needs. Thus, I am effectively locked out of the affordable coverage market (other than the useless limited benefit plans that many small employers and even the WalMarts of the world now offer, in order to check the box that they offer “health benefits” to their employees).
    As I said elsewhere, underwriters should operate as “publically accountable trusts”, and not as unbridled for profit entities who only undermine the hope for health security by their MLR/MCR and EPS orientation. There are just too many payors, each creatively trying to cherry pick and push or limit their risk elsewhere. This “cost shifting game” MUST END. It is NOT in the interest of public health security. We need a handful of dare I say “SuperMEds”, operating under the rules set by non partisan and independent public/private oversight.

  6. As a 35 year old cancer survivor, I am forced to rely on employee based insurance. However, I am trying to start my own online business instead. If I am unable to obtain insurance for my check ups then that could be a death sentence for me. I don’t have the answers nor do I necessarily advocate universal coverage but something needs to be done to fix the current coverage issues.
    One call that we do need to make is with the politicians in congress. If they are unwilling to work together or they act with special interests in mind then we need to get them removed and not replace them with like-minded individuals.
    Health care does need to be a major issue and if a candidate has a great plan that appears feasible then we should unite and not fear crossing party lines.

  7. I am amazed at the amount of cynacism that abounds in and out of the healthcare industry – though I should not be after four decades in the industry. I keep saying that if you are going to be a change agent of any kind you need to step to the other side of the door and not decide you can solve the issue by looking through the keyhole. There are so many moving parts and concentrating on just one does not assure the rest will be addressed in any way. Brian, as you indicated there are a number of entities working quietly to solve the problems by simply breaking the issue into parts and addressing them individually and ultimately collectively. It is the only strategy that will work! They are cutting costs without cutting benefits and ending up retaining and recruiting a quality workforce. I am truly a “tired boomer” but one that knows there are answers that work but are hampered by cynical individuals, political parties, carriers and others on the wrong side of the door – except for when it comes to “shareholder value and executive compensation”.

  8. What a waste of money! Tired boomers spouting platitudes. I wonder what the message is going to be in the third, fourth and fifth versions of this ad: “Just make sure all of our services are covered?”
    Who watches TV anyway? Obama will text his VP choice.

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