My Healthcare Strategy For Obama

So, this is getting messy quickly.  Support is waning.  The public is confused.  It’s time to do something.

If I put myself in your shoes [President Obama] here’s how I would have proceeded:

  1. Make 2009 about the uninsured.  Focus on one problem which is achievable – coverage for all.  You would have people rallying around you.  And, if the numbers that I have seen are right, the net costs to the insured population would be the same.  Right now, they pay for the uninsured through higher bills from the providers who ultimately have to cover their bad debt. 
    • Challenge – getting the providers to agree to lower their rates once their bad debt dropped.
    • Financing – short-term coverage of the 12-18 month lag between coverage and rates dropping.  long-term mandate with costs covered by taxes for those who can’t pay.
  2. In 2010-2011, I would take on the issue of evidence-based medicine, comparative effectiveness, and health IT.  I would save health reform for my second term (if I got one). 

    Everyone knows the system is broken.  BUT, I would stop talking about a trillion dollars in cost to fix the system.  Think like when we stretched to put a man on the moon. 

    Set a goal of “designing a healthcare system in which the total cost per individual is no more in 2020 than it is in 2010.” 

    Now, you can get people to rally around your efforts to save a trillion dollars and get us out of debt as a country. 

    The goal of keeping everyone happy and taxing the rich plays well on TV, but it’s not reality.  People can’t have their cake and eat it to.  People are going to have to give up some of the luxuries in the healthcare system.  We can’t have defensive medicine.  We have to have some limits on litigation.  We have to have health IT to push evidence-based medicine.  We have to reward people for actively managing their health. 

One of the winning strategies for you in the campaign was a simple focus on change.  You can’t change everything at once.  People have limited capacity.  Think like a program manager – phased implementations; goals people call rally around; simple wins.  People don’t understand what a trillion dollars is.  People can’t focus on 10 year plans. 

Healthcare is complex.  Focus on making it simplier:

  • Get universal coverage.
  • Establish standards of care which are driven by technology.
  • Hold costs flat.

2 Responses to “My Healthcare Strategy For Obama”

  1. You wrote, “…getting the providers to agree to lower their rates once their bad debt dropped.” How much would you drop your rate of pay if all your current debt was erased? Think in terms of a drop in your salaried rate, or profit sharing rate. How much less each month?

    You wrote “long-term mandate with costs covered by taxes for those who can’t pay.” This is where you lose me. More taxes is not the answer.

    You wrote to the President “Think like a program manager.” He can’t, he thinks like a community organizer. That’s it. He knows nothing about health care or economics. He delegates everything to “czars” who are driven by ideology — not the public good. These folks don’t think in terms of efficient program management.

    Yow wrote “People don’t understand what a trillion dollars is.” Right now its about $98,000 per tax payer (i.e., national debt x .64 [adults] x .60 [adults who pay taxes]. The 40% of adults who do not pay taxes want health care reform because they know they won’t have to pay for it.

  2. Here is a better option, put it to a vote, let the people decide. Write the bill, let the people have time to read and debate the bill. Then let the people decide if they want this monstrosity. The Dems won’t let that happen for two reasons: 1. they don’t believe we are as smart as they are and are incapable of running our own lives; 2. they understand that the vast majority of the people are insured and happy with the insurance they have.
    We are talking about 47 million people, the vast majority of which are either illegal aliens that can get government healthcare back in Mexico where they came from, or young people who chose to forego healthcare to spend their money on other things. There are in fact only about 15million people in this country that are uninsured because they can’t afford the insurance they want. Those people can easily be covered by Medicaid with nothing more than a simple adjustment to Medicaid. The vast overhaul of the healthcare system is unecessary.

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