Fostering an adult conversation about health reform

Zeke Emanuel and Shannon Brownlee have an op-ed in Sunday’s Washington Post that should be required reading for anyone interested in health care reform.

The title is, “5 Myths About Our Ailing Health Care System.”

They suggest the “5 Myths” are:

  1. America has the best health care in the world.
  2. Somebody else is paying for your health insurance.
  3. We would save a lot if we could cut the administrative waste of private insurance.
  4. Health-care reform is going to cost a bundle.
  5. Americans aren’t ready for a major overhaul of the health–care system.

At one level I can disagree with many of their points and at another I can agree with all of them — but they are right on all counts.

For example, as I have argued on this blog before, Americans are nowhere near ready enough for health care reform because most in the middle class who vote have good health insurance paid for by their employer.

As a result, voters don’t have a big reason for change in this regard—no matter the real costs of health care. But, as the authors point out, our people are in fact paying for their health care through lower wages and higher taxes.

What Emanuel and Brownlee are doing is having the kind of adult conversation with the public that our national leadership really needs to have in order to be able to build the necessary underlying consensus for health care change.

Without that kind of conversation, continuing with the same example, our people will never understand that the employer support for their health insurance costs they are enjoying is in fact illusionary. Until that, and so many of these other points are broadly understood, we will never have the consensus we will need for successful reform—getting it passed or doing it right.

Our health care access problems are symptoms of the real problems—uncontrolled costs and inadequate quality.

Today in Washington, most of the political discussion is heading toward a big expensive comprehensive Massachusetts-like package that really wouldn’t change anything, would probably make underlying costs worse, and would likely not even pass—falling of its own weight before the year is over. But the current effort does address many of the superficial political problems our health care system presents—particularly on access—while more often only giving cursory attention to the underlying cost and quality issues that are driving the access problem in the first place.

To build the kind of broad public consensus for the health care change we really need, it will be important to build a solid foundation that addresses the more politically problematic cost and quality issues as a priority at least equal to the access challenge.

To build that foundation, our leaders need to start addressing these more problematic challenges. They need to do that with facts, get beyond the simplistic myth-filled discussion we are used to that often drives the debate, and take the time to build the consensus required for any real reform.

We don’t have time? We are about to waste 2009 and have little or nothing to show for it at the rate we are going.

As the authors put it, "Now is not the time to think small, to cover a few million Americans and leave the bigger job of controlling costs and improving quality for another day."

Now if we could just figure out a way to get Zeke an audience with the new administration…

Robert Laszewski is a long-time Washington health policy insider. He writes the nonpartisan blog, Health Policy Marketplace & Review, where this post first appeared.

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Caregiver SpecialistsGreg Matthewsinchoate but earnestjdDeron S. Recent comment authors
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Caregiver Specialists

Thank you very much for this valuable and important post. This is the type of post we are looking for our post. It provides information and education regarding health care to us. So once again thanks for this fabulous post.

Greg Matthews

I am glad to see Dr. Emmanuel getting a broader audience. His book – Healthcare, Guaranteed – was outstanding.
I was really dismayed during the recent election campaign to hear both candidate spouting dumbed-down nonsense about healthcare reform (although at the end of the day I felt better realizing that their proposals were both so stupid that neither would ever be enacted).
I think that it’s important to keep the debate going, and keep getting these ideas out there.

Deron S.

jd – The biggest downside to that approach is the fact that you would be increasing access to a system that is costly and does not have the primary care capacity (or morale) to handle it. It sounds too much like a political “workaround”. We shouldn’t dance around our problems because that will only cost the taxpayers more money. Obama needs to show that he has a backbone to make the tough decisions, which will cause those that profited from our broken system to give something back. If we do it any other way, we are using a broken political… Read more »

inchoate but earnest
inchoate but earnest

in social terms, health calamity is the experience of relatively few of us. Health inconvenience is far more common. Current healthcare delivery modes too often treat conditions generating the latter as if they were the former, for a variety of reasons. That practice almost ensures that more of the former types of events occur than might otherwise. Because inconvenience affects so many – unlike calamity, which “happens to others” – broad swaths of the populace can be enlisted in support of reducing healthcare inconvenience (the inconvenience of routine checkups, innoculations, etc). If adroitly coupled with steps to broaden access, broad… Read more »


As a matter of policy, I agree with Mr. Laszewski that we need a cold, blunt assessment of our problems and we need a comprehensive solution that solves the cost/quality riddle. As a matter of politics: fat chance we’re getting that now. The recession certainly makes it easier to get some concessions in the way of value-based payment, or lowering specialist incomes to improve primary care incomes, etc. But I see no indication that we can do anything that really makes a big dent in the price of care in the next two years. Reforming the system to generate lower… Read more »

Deron S.

I agree that we are “paying” for our health insurance. The problem is, someone else is “purchasing” it so we don’t know we’re paying for it. That’s the same as someone else paying for it and it’s providing the “insulation” many of us are talking about.
You’re speaking my language when you talk about addressing the real cost drivers instead of focusing on covering all citizens and reducing insurance company waste.


Given that Zeke is Rahm Emanuel’s brother, my guess is that his thinking has an audience in the Obama administration.


10-21-2008 Health Care by: Everyone who has been to a doctor in the last year. The most important economic issue of 2008 To paraphrase Senator McCain, the loose tax dollars in Washington DC have turned good statesmen into corrupt politicians. But, his statement is just the tip of the iceberg. Not only has it turned good statesman into corrupt politicians, but it has turned kind and caring doctors into parasitical thieves. Money is not the root of all evil, but the Love of money is the basis of most corruption. In years past, if you found a man hanging from… Read more »