Series Introduction: Macro Issues in Health Care

Image: Click (http://www.morguefile.com/creative/click)

While I try in this space to bring some knowledge of organizations to give some insight into why things happen the way they do in business and government, I haven’t written anything in the last couple of weeks, and there’s a good reason:  most stories are being drowned out by the health care debate.  It’s time to contribute something to that debate.

This is the first of a series of posts in which I hope to add a few dispassionate macro observations to what has been a maddeningly dishonest micro debate.  Some of the topics I plan to address:

• The drivers and resistors of change and stasis in the system
• The interconnection of the various players in the system
• Politics, power, and popular opinion as determinants of health care
• A Balanced Scorecard approach to assessing the US health care system
• Proposed alternatives for continual improvement

The process of reconsidering health care will be one of the most profound changes in the history of the United States, no matter what happens.  If there are structural changes to the system, more people will be covered and more things will be handled differently than ever before.  If the effort fails, the country will have learned new and effective methods for blocking change, methods sure to be revisited by both sides in all manner of future endeavors.  Whether the change is in health care, politics, or both, we are entering a new period in massive trans-organizational change.

What this series will not be is political or tactical.  What it will be is broad and long-term.  My own views are fairly pragmatic as health care is concerned, and let me disclose them from the start:

• I believe that all Americans should have access to routine health care.
• I think that anyone currently covered should retain that coverage as it is now.
• I think that the level of health of all Americans is an economic and national security issue.
• I do not believe that insurance companies are especially greedy.
• I believe that it is morally unacceptable to deny coverage to those with pre-existing conditions.
• I think that it may be economically infeasible for insurance companies to cover pre-existing conditions.
• I believe that it is a breach of an implicit contract to cancel coverage when a person gets sick.
• I think that insurance companies may not be able to afford to pay for many expensive illnesses.
• I think that insurance companies’ inability to compete with a public option on cost or level of service is a clear sign that insurance companies must become better businesses.
• I believe that insurance companies should compete more openly.
• I believe that citizens should feel the financial effects of their health care choices.
• I believe it is in the nature of the American people to want to be the best at everything it does.
• I believe that the United States should be intensely competitive in pursuing the best system in the world.
• I believe that Americans should stop attacking each other and begin attacking the problem.

To paraphrase a sentiment from last year’s campaign, this is no time to make big crises about small things.  I hope I can contribute some helpful insights about the broader, longer view, and I hope you’ll contribute your own insights and suggestions.  It’s time to pursue understanding.