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Bending the curve or breaking health care: What price reform?

The rush is on in Washington, D.C., and in statehouses across the nation to curb medical costs and to change how American health care is funded and delivered -- change sought by physicians, patients and payers alike.

How we arrive at any change, though, needs to be handled carefully and thoughtfully. Setting deadlines for bills by mid-June in order to have a product for presidential signature by summer's end is politically motivated and unwise. An expedient and political solution could have unintended and disastrous consequences for the delivery and quality of American health care for years to come.

Rather, solutions must be crafted to avoid the many pitfalls in reform that could physically and fiscally be worse than the broken system we have today.

Our current health care crisis did not develop overnight nor can it be instantly resolved, yet Washington appears bent on arriving at an immediate solution to the growth in medical costs -- or "bending the curve" -- no matter the impact on individuals or the nation as a whole. Multiple ideas are on the table, with little rational thinking behind them. What seems most important right now in Washington is to do something, to do it this summer, and then to crow about having "fixed" the problem.

We need a sane approach that includes input from all stakeholders, with appropriate time given to the analysis of each proposal to ensure long-term success. What remains to be determined is which proposals to include. Employer and/or individual mandates? Addressing costly waste and profiteering in the insurance sector? Expansions or combinations of existing public programs such as Medicare, Medicaid, Healthy Families and possibly workers' compensation? Taxing health insurance benefits above some defined level? Medical malpractice reforms? Resolution of conflicts between state and ERISA protections? Defined basic benefits packages with options to buy additional coverages? Health insurance exchanges? A public plan backing up or competing with private payers? Accountable care organizations with new paradigms of payment to multiple providers?

Each of the above has its merits and its problems, but in some combination could resolve America's dysfunctional health care delivery system and unfair payment formulae. Hurriedly dictating any solution from a legislative pulpit to gain brownie points with voters would more than likely cause stakeholders to dig in. It would create unanticipated problems in the integration of the many facets of care and funding, and would most likely fail to effect true health care system reform, Ă  la Hillary vs. Harry and Louise.

As President Barack Obama has stated, we do not want to lose the current momentum to finally deal with this issue, an issue that has haunted this nation with failed attempts at reform like clockwork every 20 years since Franklin Delano Roosevelt. Health reform has rightfully become a focus of both political parties, and there is a genuine interest by organized medicine, insurers, businesses, hospital organizations and legislators at all levels to find real solutions to the only-too-real problems of the uninsured, affordability and quality improvement.

Allowing needed time for fair and open debate and compromise among policymakers and those in the trenches of health care delivery before a workable model of health care reform is achieved can result in more-likely-to-succeed models than a quick and forced political solution. This approach may not bring a quick plan to the floor of Congress this summer, but the long-term outcome will more likely be broad-based and acceptable to all parties. However, what is currently shaping up to be a set of competing proposals from the House and Senate will surely engender partisan and stakeholder angst, opposition and ultimate failure.

It is time for reform. No one can argue that. Our current health care crisis is an urgent one, but not an emergency. In medical care, emergencies call for STAT responses that often are reflexive and not considerate of long-term needs. Urgent problems call for rapid responses that include reasoned thinking and interventions, but that also allow for consideration of multiple interventions and the choice of those that best effect immediate and long-term benefits.

Health reform could fall apart in the rush to pass a political solution, resulting in a sum total of nothing, or at least nothing worthwhile. We all deserve and need better than that, and could wait a few months longer to do it with broader input and workable results. The price of those few months is low and the value inestimable in doing it right.


Mazer, M.D., an otolaryngologist in private practice in San Diego County, is past president of the San Diego County Medical Society and current trustee of the California Medical Association.

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