Acknowledge The Need For A Transition Period

In order to successfully put together the politics of health care reform, we have to be able to separate the process of agreeing on the vision - on deciding what the purpose of the health care system should be; and on what we want it to do - from the process of realizing the vision through the political process.

In other words, we have to acknowledge and legitimize the politics and economics of reform and make them explicit.

And if we can do that we are then in a position to design a series of incremental steps which, over time, can gradually shift the trapped equity in the current system to one that is more effective, efficient, equitable, sustainable and more aligned with the long term interests of our nation without disrupting either the delivery system or the economy in the process.

Dr. Don Berwick, founder and CEO of the Institute for Healthcare Improvement, describes this challenge by comparing the Vision of a new system (the future state) and the current system (current state) with the economic burden on the various stakeholders involved. If we could move from the current state to the future state while reducing economic burden on the stakeholders, the politics would be simple and straightforward. Everyone would win.

The problem is that – because of the significant trapped equity in the way our current system is organized and financed, the economic burden is likely to go up for most stakeholders during the transition period. And, as described earlier, these stakeholders all have a significant influence over the political process and are able individually and/or collectively to block anything that will adversely effect their short term economic interests.

The challenge for us is to make the politics and the economics of this transition period explicit by starting with an agreement on the future state.

This will allow us to move beyond the political gridlock by shifting the focus of our discussion and our energy away from the narrow debate over how a particular reform strategy will effect a given economic stakeholder to a broader discussion:

• first, of what we want our health care system to do - what we want it to deliver us as individuals and as a society; and,
• second of how the economic impact of these changes on any given stakeholder can be mitigated during the transition state.

However, without first agreeing on where we want to end up, there is no political pathway for us to get there.

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