Robert FrombergEditor-in-Chief, HFMA
I demonstrated some inside-the-box thinking the other day in a discussion about payment-system reform.
I was on the phone with a freelance writer discussing interviews he would be conducting for an article about overcoming barriers to changing the healthcare payment system.
“Don’t spend much time talking about a single-payer system,” I said.
“Why not?” he asked, a bit of a challenge in his tone.
“Well,” I said, “no way is a single-payer system going to happen, and it’s a fairly short article, so I don’t think we need to do much more than mention it.”
In my mind was an article in the Christian Science Monitor (“Healthcare Crisis Countdown,” Nov. 11, 2006) that quoted Robert Blendon of Harvard as saying that a single-payer system is “not likely to be given a fair examination” because of “cultural resistance.”
The article went on to list the interest groups that object to a single-payer system and to note that when a single-payer system was on the ballot in California and Washington, opponents devoted a great deal of money to successfully trouncing the proposals.
The consensus of the experts interviewed for the Christian Science Montior article was that the state of the healthcare system would have to become even more dire than it is today for a single-payer system to receive a fair hearing.
All of which could be construed as a reason not to devote much space in a short article about payment system reform to a single-payer system.
Or it could be construed as a reason to encourage consideration of radical reform.
The central finding of Consumerism in Health Care, the most recent PATIENT FRIENDLY BILLING® report, is that stakeholders with divergent goals must work together if hospital pricing is to be more rational and meaningful for consumers. In his HFMA Views post "Those Devilish Details," HFMA President and CEO Dick Clarke writes, “strengthening Medicare’s financial status will take a collaborative approach with all options on the table.” In the forthcoming March issue of hfm, HFMA Chairman Joe Fifer writes in his column, “While some states and communities have stepped into the land of uncertainty with innovative solutions, I see little of that at the national level.”
Solving the healthcare crisis will come about only if stakeholders who rarely talk with each other start talking, and only if they talk about solutions they find unfamiliar and uncomfortable. Allow me to enjoy a moment of idealism: Imagine the change that would occur if everyone reading this magazine were to pick up the phone this week, call a stakeholder in the healthcare system with whom the caller usually doesn’t talk (a large employer, a payer executive, a community activist), and discuss one idea for healthcare reform—preferably one that is downright unrealistic. Now let me extend that idealistic moment and imagine what would happen if every month (or, dare I dream, every week) everyone who read this magazine made such a call.
Perhaps such a call would be made in the context of a specific, current issue of concern—a new price-transparency or community-outreach initiative. But I also like the idea of scheduling time to share ideas beyond what is happening today, ideas about what the health system could be, as well as specific actions to move toward that future.
As for me, I will make at least one call. I will call that writer back and let him know it’s OK to dream a little.
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