HFMA recently asked David Gergen, adviser to four presidents and well-known political commentator, how our nation's political leaders could deal with the problem of the uninsured. Here is his response.
The political leaders are unable to take decisive steps because there’s so much division within the healthcare industry itself. Any comprehensive solution proposed in Washington is inevitably going to draw fire from one or another interested party, so it’s very difficult to achieve consensus in Washington. The parties are terribly split.
But I don’t think you can blame this solely on the politicians. What we have learned over the years is that the divisions in our politics reflect divisions in the country and within industries or among groups. And one of the reasons you can’t get consensus in Washington is there is no consensus within the healthcare field about how to solve some of these problems. So it’s going to have to be a partnership among a lot of people to get serious reform.
One bright spot on the horizon right now is in Massachusetts with the embrace of a new statewide system that seeks to ensure that all citizens of the commonwealth have health insurance and that costs are affordable. That Massachusetts breakthrough represented a compromise by numerous special interest groups, as well as by politicians. We’ll have to wait and see whether it will work, but I think it points the way toward the kind of solution we’re going to need over time--that is, that the only way we’re going to gain a consensus is for people to be willing to give up some of their sacred cows.
My sense is that major corporations in the country are trying to get out from under the healthcare responsibilities to their employees. So we see the Wal-Marts and others that are not providing the kind of healthcare insurance that we would normally like to see. That trend is going to continue. Healthcare costs are like a tax. Corporations facing heavy taxation of healthcare are going to do one of three things: They are either going to reduce the number of employees to whom they offer health insurance in the United States, or they’re going to move the jobs overseas, or they’re going to seek some solution outside the corporation or some different method of running a healthcare system.
It is inconceivable that corporations will sit quietly and embrace a healthcare system that costs 25 percent of the GDP. That’s just not going to happen. So I think change is coming. What kind of change--whether it’s going to be good change or not--is hard to say. There are some corporations today that are speaking much more favorably about single-payer systems than ever before, to my surprise.
David Gergen will be speaking at HFMA's upcoming Annual National Institute June 18-21.
