We Can Improve Healthcare by Exchanging Ideas

The writer is hosting a State of Reform Health Policy Conference at the Oregon Convention Center Dec. 13

OPINION – November 26, 2012 -- If you had five minutes with the Governor to talk healthcare, what would you say? That’s the question we asked 17 healthcare, business, civic and legal executives from across four states: Washington, Oregon, Idaho and Alaska.

The response, collected in a new book titled “Dear Governor: About The State Of Reform,” offers readers perhaps the most sophisticated level of discussion and analysis of state healthcare policy in the northwest.

The four states are as diverse as any in the country, ranging from fully engaged in reform to fully oppositional. It reminds me that the old adage about physician offices rings true with the states: if you’ve seen one state address the challenges of healthcare, you’ve seen only one state. In other words, the reforms implemented in a state like Oregon are an uneasy fit for a state just across the border.

These are interesting times in which we live. From healthcare, to the economy, to our civil discourse, now more than ever we need a thoughtful forum in which to engage the most pressing challenges of our day.

You find that sort of vital engagement here on The Lund Report.

You also find that kind of thoughtful discourse and exchange of ideas at the State of Reform Health Policy Conference. This year’s conference is being held on December 13th, and includes a keynote address from Dr. Don Berwick, perhaps the nation’s leading advocate for system improvement and innovation.

It includes over 50 speakers from across Oregon’s healthcare system, and close to 100 organizations – so far – already committed to attend.

Perhaps now more than ever, this kind of forum is vital to the exchange of ideas and collaborative information sharing that can help improve our healthcare system.

There are a hundred reasons why this is the case. Let me give you two reasons that I think are so fundamental to the work we are all doing in healthcare that they often get overlooked.

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There is no other industry – save for defense – that is as highly intertwined with, reliant upon and regulated by government than the healthcare industry. From licensing to Medicare, from CCOs to medical degrees, healthcare exists almost entirely within the regulatory framework of government.

However, the lack of knowledge about how government operates among the broad spectrum of healthcare players is significant. In fact, I would argue that the only place that lack of knowledge is matched is by the dearth of understanding among many policy makers about how the healthcare system really works.

This shouldn’t be a surprise – and it’s certainly no overstatement.

If you consider how the world of healthcare functions – from financial incentives to education and training – the culture of healthcare is one of specialization. Put another way, in healthcare, it pays to be a mile deep and an inch wide.

The opposite is often true in politics. Successful politicians are often able to see the big picture, connecting dots into patterns that can form policy. They are often adept and knowing a little content about a lot of topics – so as to not look silly when asked questions by reporters or constituents. To stick with the previous metaphor, in politics, it pays to be a mile wide and an inch deep. This is the culture of generalization.

These two cultures go together like oil and water. Both cultures often think the other “doesn’t get it.” The “god complex” of one culture shies away from the “god complex” of the other, and so on.

This is one reason a forum like State of Reform and online healthcare news sites like The Lund Report are so important – vital, in fact – to the future of our healthcare system. These efforts bridge the gap between the culture of specialists and the culture of generalists.

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The passage of the Affordable Care Act represents the most transformational piece of healthcare legislation in almost a half century. It reshapes the insurance marketplace for consumers, provides funds to expand coverage, and supports innovations in payment reform and care coordination that have tremendous potential.

It has also helped create more uncertainty, anxiety, and nervousness in the healthcare marketplace than at any other time in recent memory.

In fact, there has not been this much change happening in healthcare since the advent of Medicare and Medicaid under Lyndon Johnson’s “Great Society.”

In economic terms, however, there has never been more riding on getting that transformation in healthcare right.

In the last four years, the “Great Recession” has struck America like a sledgehammer – hitting all states, but states like Oregon and Washington harder than many others.

While statistics can sometimes blur a basic narrative, here is the bottom line for all of the four northwest states that we track (OR, WA, AK, ID): the number of unemployed citizens is up over 4 years ago in every state we cover.

In Oregon, there are 21% more unemployed workers now than four years ago. That is a shocking, disheartening number.

Change from 9/08 to 9/12





Size of the Labor Force





Number of Employed Workers





Number of Unemployed Workers





And it is the second fundamental reason why collaboration to improve our healthcare system is so important.

We cannot afford the healthcare system our country deserves without getting our economy moving again. There are too many people out of work and too little economic activity to fund Medicare, to fund the exchange subsidies, or to fund employer-based health premiums given the customary medical rate of inflation.

If we want to fix healthcare we need to get people back to work. To get people back to work, we need to fix healthcare.

Costs on employers and on government to fund healthcare are simply unsustainable.

This is the second reason why initiatives like the State of Reform Health Policy Conference and The Lund Report are so important: improving our healthcare system corresponds closely to getting our economy moving again and our neighbors back to work.

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Healthcare is a polarizing topic these days. However, it makes what you are doing in healthcare – and what we’re doing at State of Reform – all the more important.

It comes down to this: in a republican democracy, whether you are a Republican or a Democrat, we are all in this together.

DJ Wilson is the editor of “Dear Governor: About the State Of Reform” and the host of the State of Reform Health Policy Conference which is being held at the Oregon Convention Center on Dec. 13th.

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