It's no secret that local and national politics are bogged down these days, and it's quite likely that healthcare reform has received more attention via campaign slogans rather than examples of meaningful change. But even though the government and the private sector can't seem to cooperate on core economic, social or policy measures, those of us in the industry know healthcare quality, safety and service matter—perhaps even more so today than any other time in history.
So what comes next for healthcare reform? The answer is largely dependent on what happens during the 2012 elections. If President Barack Obama remains in office and the courts don't significantly alter the administration’s ability to develop comprehensive national healthcare, it's likely the pace and depth of reform will intensify. On the other hand, if the White House changes hands, it's highly likely reform may track toward private-sector engagement and non-governmental models.
Either way, the world of healthcare will change. The only real questions are: In what direction will it go, at what pace and in what manner? The answers, which will universally affect everyone in the country, will have to be addressed by national or state public policy decisions. Additionally, the answers will be heavily influenced by individual choices related to insurance options and care providers. The future of healthcare is also inextricably linked to our nation's economy. Healthcare spending accounts for nearly 18% of the total U.S. gross domestic product (GDP) and greatly affects public and private sectors.
The fact is, demands on healthcare providers, hospitals and EMS will continue to change at a rapid pace and no nice, neat compendium summarizing the future of American healthcare can be created because any manual would be obsolete before the ink had a chance to dry.
A good example of this constant change is the interlude of Donald Berwick, MD, MPP, as head of the U.S. Center for Medicare and Medicaid Services (CMS). Berwick, a pediatrician, Harvard professor and founder of the Institute of Health Improvement, is known by many providers as a renaissance man on such issues as access, cost and quality. His ideas—and those of the Institute of Health Improvement—are light years ahead. Thus, it was no surprise when Obama tapped Berwick to lead CMS in April 2010, just a month after the Affordable Care Act became law. Berwick developed recommendations for just about every aspect of healthcare delivery, making many providers nervous.
Unfortunately, many times people who, like Berwick, suggest change pay a price for doing so. It was no surprise when the U.S. Senate refused to confirm Berwick’s appointment. Thus, he served in an interim role and was never permanently appointed. Berwick’s major sin, according to some in Congress, was that he dared mention how some programs outside the U.S. had merit and should be considered when designing ways to address healthcare issues in our own country. Berwick never said outright that the U.S. should adopt a foreign system, but he supported considering embracing elements that may fit into America's model.
Regardless of who is leading the charge, policy decisions do not absolutely define a path, nor do they permanently fix a problem. Every action we take can be linked to an event, an idea or a need. I expect when we're reflecting on the era of healthcare reform 50 years from now, the core issues will remain the same; access, cost and quality. Until everyone has access to care, there will be issues with those who don't. Until the cost of healthcare can be brought into some reasonable range, it's impossible to fix access. Until we can address access and cost, it's unlikely that real quality will exist for everyone in need of care.
These are the conundrums we face when dealing with only select aspects of healthcare vs. addressing systematic issues. In other words, to fix one major issue, you must be willing and able to take on all major issues related to healthcare—even if such a commitment must occur in a sequence. With our current political climate, it's clear that isn't possible. But, we have to start somewhere, and we must collectively determine a launch point and start fixing the issues.
Reform leaders must be courageous enough to step forward and risk everything for what they believe is important. I have no doubt Berwick will do just fine without employment by the federal government, but the controversy around his appointment highlights the fact that healthcare reform is complex. And it will remain that way for everyone involved in decision making as well as on the peripheral.
I am confident that we will make the right decisions, including the placement of EMS in and around healthcare. It would be naive to suggest the course has been preset, or that it's easy to discern. Often change is a product of chance and the chance of a good outcome is substantially improved when educated, caring, and compassionate people become involved in setting the course. My challenge to you is to be part of the solution and have the courage to lead—regardless of whether you encounter resistance.