What I Learned About Health Care in the 1990s
Dick Gephardt was a leader in Congress 15 years ago, when the last major effort at health-care reform fizzled. He reflects on keeping medical costs down and keeping politicians focused on real change.
Americans care a lot more about health care than about politics.
With the growth in health-care costs skyrocketing higher each year, people are demanding change in our health system. In our current economic environment they will be disappointed, and justifiably so, if this opportunity to improve the health-care system is squandered by the political ghosts of the past.
It is important to learn from the lessons of the 1990s, when the nation lost an opportunity to reform the health-care system. The people on Main Street, this time around, will have little patience for political grandstanding.
There is a new consensus on Main Street. As an illustration, business and labor unions are joining forces to figure out ways to achieve health-care reform and fix the health-care system, largely by bringing down skyrocketing growth in health costs without sacrificing quality. This kind of cooperation would have been unthinkable 15 years ago, when division ruled the issue. But it has become clear to people on all sides of the bargaining table that runaway health costs are crushing businesses and hurting families.
As President Obama has put it, achieving affordable health care for all will remain out of reach unless we can find ways to bring down health costs. The American people get this, regardless of their party affiliation.
It is important to learn from the lessons of the 1990s, when the nation lost an opportunity to reform the health-care system. In that go-around, political divisions too often trumped productive discussion, partisan attacks overwhelmed thoughtful analysis, and the vital national concerns of health-care costs and coverage became obscured by caricature and name-calling. The people on Main Street, this time around, will have little patience for political grandstanding.
Naturally, there will be differences, and no side or stakeholder will win on every measure. But the tactics of everything-or-nothing will simply make losers all around.
Major American businesses and labor unions are working together in an alliance called America's Agenda that is calling for a break with the polarizing political habits of the past. The group is calling for a different approach, building consensus around reforms that can improve health care and lower the growth in costs for businesses and families. It's an approach that is uniting businesses, labor, and health-care providers behind real, systemic reforms that will strengthen what works best in American health care, yet stem the unsustainable rate of growth in our health costs.
Any successful reform plan has to find ways to prevent the onset of chronic diseases like diabetes, cancer, and heart disease before they begin. It can be done. According to the World Health Organization, some 80 percent of heart disease, stroke, and Type 2 diabetes—and 40 percent of cancers—could be prevented if people ate healthier, exercised, and stopped smoking.
Yet a mere 1 percent of our health-care dollars are spent on prevention. We need to start spending our precious health-care dollars in ways that keep Americans fit. We need to promote good health long before someone needs to be rushed to an emergency room. The federal government has an important role to play in leading coordinated national campaigns against smoking and for reduction of rising rates of obesity that are linked the epidemic growth in a list of costly and ultimately fatal chronic diseases.
Americans are served by the most highly skilled medical professionals in the world, but they work in a highly fragmented health-care system that fails to reward teamwork or encourage coordination among health professionals in the prevention or treatment of disease. Private-sector experience has demonstrated that fragmentation can be overcome. Health providers like the Cleveland Clinic, Geisinger Health System, and the Mayo Clinic are leading the way and succeeding in placing patients at the center of their own health care, with the support of a coordinated, personal team of health professionals. These providers reward best practices in patient care, rather than volume of services prescribed. They facilitate coordination among physicians and their health teams in caring for patients. They link providers and patients with health-information technology that allows them to disseminate up-to-date information and facilitates coordination of care. The results speak for themselves: cost growth declines, patient outcomes improve.
One of the smartest investments our country could make—one that would save both money and lives—would be to model federal reform on successful private-sector innovations like these.
Today, too many Americans are living without health care coverage—or in fear of losing it. Soaring health costs are one of the most pressing concerns for families and businesses. It keeps people up at night. Lawmakers need to find a way to bring them some peace.
Dick Gephardt serves on the board of directors of America's Agenda. He is a former House Democratic leader and is president and CEO of Gephardt Government Affairs.