Ten Game Changing Assumptions Shaping Health Reform

The author maintains that the Oregon Health Plan rationing experiment was a colossal hoax and channeled billions of new dollars to Oregon’s healthcare interest.

OPINION -- All problem-solving methodology is constrained by the assumptions influencing the process. Many are certainly arguable but if we were to agree to the following list, they would have profound impact on almost all aspects of our current and past reform efforts.

1. The ideologies of the left and right will not sustain a reform solution grounded in compromise and “deal making”. The endless search for consensus confuses the problem, and is a recipe for failure.

2. The State’s public bureaucracy is too conflicted with its own self-interest to impartially govern health reform.

3. The plethora of proposed actions to reduce demand will not reduce costs. “Supply” being a more important driver of costs than ”Demand.”

4. Sustainable reform cannot tolerate the variation in provider pricing to patients with differing sources of payment. Perhaps less than 15% of the typical hospital’s patients pay what the hospital bills.

5. It is wrong headed to view reform as a matter of amending the existing system.

6. Financial goals stabilizing healthcare costs cannot be achieved without prospectively stated and independently measured metrics.

7. Equal access is not a realistic expectation. Universal coverage must be.

8. Genuine altruism is a deceptive and widely abused value of our non- profit institutions and trade associations.

9. The United States spends twice as much per capita on healthcare because our healthcare workers of all stripes take out twice as much from the system.

10. The healthcare structures of other countries, while instructive, are not transferrable to the United States.


The Oregon Health Plan rationing experiment was a colossal hoax that channeled billions of new dollars to Oregon’s healthcare interests. Never measured, never critically evaluated. A classic example of the “Emperor Wears No Clothes.”

Conclusion: Imagine 2-3 alternative systems reflecting the differing ideologies: Liberal / Conservative / Libertarian.

What would this suggest for process?

  • Form three small task forces assembled around three ideologies: Liberal, Conservative, and Libertarian to articulate assumptions, problem definition, and a broad solution compatible with each ideology.
  • At the end of the process examine what consolidation can occur and if not presume the development of three systems available to the free will of people to chose.

Liberal: Socially and fiscally liberal

Conservative: Fiscally and socially conservative

Libertarian: Socially liberal / Fiscally conservative

Note: The prospect of three systems capturing U.S. Healthcare, sounds daunting but in reality we have more than that now: Employer, Medicare, Medicaid, TriCare, Municipal, Insured, Self funded etc.

Additional Assumptions:

1. A sustainable health reform strategy cannot be achieved without the foundation of a well-conceived definition of the problem and formative assumptions.

2. Subsidized or “free” health care is inflationary and will overwhelm administrative

protocols for cost reduction.

3. Financial targets will not be achieved as long as our culture overwhelmingly rejects money influencing health care demand.

4. The community’s healthcare pathology is infinite and those making a living and profits from healthcare will seek to exploit that.

5. Our healthcare system in the main is a proprietary endeavor with millions of economic interests seeking to protect or increase revenues. Any initiative that threatens that cash flow will stimulate offsetting reactions.

6. Current reform rhetoric favors limited choice, comprehensive benefits at someone else’s expense, blaming patients, and compulsory participation.

7. “Nearly half of all care delivered produces no medical benefit” is in obvious conflict with a prevailing view of vast health manpower shortages. Does increasing supply reduce prices and the costs of healthcare?

8. If the national will demands universal coverage, the utility of competing traditional insurance companies should be called into question.

9. The reformed system should promote patients seeking care from the “best” provider of care as early as possible in the development of any adverse health care condition.

10. It is unethical to impose a requirement to select a health plan, provider network, and insurance in advance of acquiring a dire condition, and then systematically lock out access to the “best” providers.

11. The ubiquitous fixation on “free” prevention as a solution for controlling healthcare costs is a phony proposition.

Stephen A. Gregg is a retired hospital administrator, past CEO of the Ethix Corporation, and long-time participant in managed care

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