The Obama administration, and advocates of major healthcare system reform, received a major boost today in the form of a joint letter (PDF) to President Barack Obama from the leaders of the American Medical Assn., the American Hospital Assn., America’s Health Insurance Plans, the Advanced Medical Technology Association (AdvaMed), the Pharmaceutical Research and Manufacturers of America and the Service Employees Industrial Union, promising support for healthcare reform.
In one fell swoop, these major stakeholders (the Biotechnology Industry Assn., third leg of the life sciences industry stool, is conspicuous by its absence here; were they too consumed by next week’s international conference in Atlanta to get on board?), each with a high short-term financial stake in the status quo, signaled unequivocally and inextricably that they are committed to a future that may be very different — in business and professional terms — from the present.
The letter lays out a few basic principles:
— Promoting administrative simplification, standardization, and transparency in support of effective markets;
— Aligning incentives among providers across the continuum of care to enable physicians, hospitals, and other health care providers to work together towards the highest standards of quality and efficiency;
— Encouraging coordinated care, both in the public and private sectors;
— Developing evidence-based best practices and therapies that reduce hospitalization, manage chronic disease more efficiently and effectively, and implement proven clinical prevention strategies; and
— Addressing cost drivers in each sector and through common sense improvements in care delivery models, health information technology, workforce deployment and development, and regulatory reforms.
There is nothing to quarrel with here. If insurers, device manufacturers, big pharma, physicians and the hospital industry can all get behind these goals — and a major labor union agrees they can do it without fatally gutting employee health benefits — we will indeed see a meaningful positive impact on the rate of growth of healthcare spending. And we will be able to divert the resulting savings to help cover those who are now uninsured.
What is surprising is the degree to which these organizations have put aside their historical differences in order to support and participate in shaping a reform agenda that may inflict real pain on their members.
So how do we understand this apparent new and progressive public-mindedness? Four possible explanations come to mind:
1. The public-mindedness isn’t really all that new; the trade and professional associations signed onto the letter have always been deeply committed to the improvement of our healthcare system outcomes, the efficiency of our investments in healthcare and the goal of universal coverage. It’s just that they’ve now come to realize that laissez-faire principles won’t get us there, and have become converts to public sector initiatives.
2. They aren’t really all that happy about the direction of reform — particularly with regard to evidence-based guidelines, realignment of incentives, etc. — but something is going to happen and they need to be at the table to do whatever can be done to protect their interests. The principles articulated in the letter are general (or is it vague?) enough to allow for considerable leeway at the point of operational definition.
3. They aren’t at all happy about the direction of reform and want to be at the table in order to delay, or scuttle, action. Maybe Obama will lose momentum, maybe he’ll stumble over something else, maybe … well, you get the idea.
4. And/or they’ve seen a future without some substantial policy intervention, and they’ve signed on to support current reform efforts because the alternative is so much worse. “We’ll take the pain and the lowered (commercial) expectations in order to avert a systemic meltdown.”
Am I too cynical? Not at all. Personally, I’m mostly at No. 2 (seat at the table to protect most vital interests), with some leavening of No. 1 (honest commitment to quality and progress in coverage) and No. 4 (the country better do something or we’ll all be in the poorhouse).
The real test is, of course, yet to come. Principles are easy; details and legislative language, like contracts, are difficult. It will be interesting to see the degree of continuing participation and the enthusiasm of support from various industry elements as the particulars of the healthcare reform legislation are defined in real and substantive ways — when the effects on constituent companies, care providers and institutions become measurable.