Richard L. Clarke, DHA, FHFMA

Harry and Louise have moved on.

I'm sure you all remember Harry and Louise, the characters in the early 1990s TV ads warning of the dangers of healthcare reform, as it was proposed by the Clinton administration. Those ads were only the most visible evidence of a struggle among the various stakeholders in our healthcare system that ultimately sank the previous effort at major national reform.

The points of contention were familiar and largely driven by the perverse incentives of our current system. Stakeholders were concerned that reform would unfairly interfere with stakeholder autonomy and that its costs would fall unfairly on certain groups.

Fast-forward to May 11, 2009, when representatives of key stakeholder groups-hospitals, physicians, payers, labor, and pharmaceutical and medical device companies-presented to President Obama a joint letter pledging to support efforts to drive $2 trillion out of the healthcare system over the next 10 years as part of an overall reform effort.

For many long-time healthcare professionals, I'm sure the first reaction was, "Wow."

Yes, negative ads about reform are in the works, and various groups are grumbling about the specifics of reform. But this level of collaboration among stakeholders whose interests are rarely aligned is significant. Why has it happened?

For one thing, we have Democratic majorities in Congress and a popular president whose campaign platform highlighted healthcare reform. In addition, the vacuum created when Tom Daschle's appointment as HHS Secretary was derailed moved power for drafting legislation to Congress, helping to engage lawmakers early in the process and begin getting their consensus. In addition, senators Baucus and Grassley-leaders of the all-important Senate Finance Committee-are steeped in healthcare issues, and although they don't always agree, they have worked across the aisle on these issues. And at least in the Senate, the process of exploring reform ideas has been more inclusive than in other lawmaking exercises.

The economic downturn also has contributed to the reform momentum. The fragile state of the economy makes all too apparent the need to change the unsustainable trajectory of healthcare costs. In addition, bailouts of the financial system and automakers may have made investing in healthcare reform more palatable by comparison.

Given these political and economic forces, a somewhat jaded interpretation of this stakeholder coalition is that they want to be at the table so they won't be on the menu. To a great extent, that is true; no group wants to shoulder the cost of reform or lose control of its role in the system. However, an equally valid interpretation is this: Members of these groups have dedicated their professional lives to making our citizens healthy. For far too long, they have been good people trapped in a bad system. They have been invited to be part of the legislative process to change this system. Perhaps the question is, Why wouldn't they collaborate?

With all of those positive forces, no wonder Harry and Louise have left the scene.

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