In a recent op-ed piece in the Oregonian, Steve Gregg challenged the various health reform proposals – including the Archimedes Movement – to focus on cost containment, and implied that all of the efforts underway are simply trying to find more money to finance the system, or reallocate what is currently available. I have worked with Mr. Gregg in the past and hold him in high regard – and while I agree with much of what he has to say, there are a few key points with which I disagree.
First, we are not seeking more money. Second, while we are certainly interested in reallocating the existing money more equitably – and believe it is important to do so – we also want to reallocate it more efficiently and in a way that is more effective in producing positive health outcomes. On our website we have stated explicitly that “if we cannot control cost, we have not accomplished anything.” And to back up that statement we are, in fact, committed to developing “credible approaches to controlling costs.”
I agree with Mr. Gregg that we cannot build a new system that focuses on health and brings cost under control with only “minimal impact” on the interest groups. On the contrary, we do have to challenge the status quo and that has been a central objective of the Archimedes Movement from the very start. We also have to alter prevailing consumer attitudes and fundamentally rethink our health care delivery and insurance systems – all of which will inevitably involve significant changes in the flow of resources, not just to service providers but to other stakeholders as well including insurers, consumers and payers.
This is exactly what we are trying to do, but not in the abstract. The reason we have not yet filled out details of the “delivery” and “payment” components of our proposal is that those are the areas where the most creative thinking – and most difficult changes – must take place. We cannot bring about the kind of fundamental reform we need without dramatic changes in the status quo. But unless we first know where we want to end up – what we think the new system should look like – we will never be able to get there. If we can first build broad consensus around the elements of a new system, we can then develop a multi-year transition strategy which will move us in that direction without creating wholesale disruption of the delivery system in the process. But the first step is to agree on the parameters of a system that fair, effective, efficient and affordable.
Finally, you cannot discuss “experimenting” or “piloting the impact” of what you propose to do unless your first know what you want to do. If we are successful in getting our bill passed in Oregon and then can move this back to Washington, D.C. for a debate over gaining the authority to implement it, we may well get wide authority to “pilot” the impact of various elements of our proposal as part of the transition strategy.
This is not pie-in-the-sky, idealistic dreaming. We have an opportunity to frame how we will approach health and health care in the months and years ahead. There may be some who still believe that if we do nothing, our health care system will remain static in the face of mounting cost and eroding access. But the numbers of those who cling to this belief are dwindling. The emerging reality is that the system we have will crumble if we do nothing, hurting our economy, our businesses and our people. Certainly, action of any sort involves risk but we need to weigh the risk of action with the risk of inaction, because our current course is neither equitable nor sustainable and the precipice toward which we are moving is much closer than we think.
I appreciate Steve Gregg’s comments and hope he will consider joining the Archimedes Movement to give us the benefit of his perspective as together we blaze a trail that works for all of Oregon.
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