As we near the end of February, many are wondering what is wrong with health reform at the federal level. People from all walks of life and every political party are frustrated with the inability of Congress to have a debate on the merits of elements in the reform bills passed by either the House or the Senate. It has brought back memories of the early days of the Archimedes Movement and why this notion of grassroots engagement – agreement on a set of principles and holding to those when things get tough – felt so important. One colleague stopped me a few weeks ago and whispered in my ear, “It looks like we’re back to a discussion of principles.” Congress didn’t agree on a set of principles to drive reform; therefore, they don’t have a way of knowing what fits and what doesn’t except to use a political yardstick. And one thing is clear – using that yardstick, everyday Americans just don’t measure up.
Throughout the past four years we have used the principles that were developed by more than 3,000 members to guide the direction and influence of the Archimedes Movement. To some it has been frustrating – feeling that principles won’t lead to reform – even though our principles were included in Oregon’s health reform legislation passed in 2007, which led the work of the Oregon Health Fund Board. Without a set of guiding principles, you are left with no measurements to help weigh the influence of powerful stakeholders.
Here’s how a set of principles could work: if you come to the agreement that at the end of the process you want a system that is affordable – to individuals and to businesses, that is accountable to the public for the trillions of dollars spent, that should provide incentives to improve health, that simplifies administrative bureaucracy, that is equitable and allows everyone a way to get the care they need, when they need it, without fear of losing their home, job or life, then each time someone asks a congressman to change an element of the bill, he or she could ask how it measures up against those principles. If the change doesn’t measure up, you work on it until you have a framework that does. There is power in agreement on principles.
It also allows for some creativity upon implementation. I know there are many who want a single system that is nationwide, but part of what we know is that health and health car is local, that it will look different in La Grande than it does in Portland; that it will look different in Kentucky than it does in Florida. If we agree on the framework that would drive the design, it leaves room for innovation and creativity. But we must have agreement on what the system would achieve – what its goals are – and that brings us to the Triple Aim. In 2008 the newly formed Archimedes Movement Community Leadership Council agreed to endorse the Triple Aim, based on work at the Institute for Healthcare Improvement: improved health of a defined population; reduced per capita cost; and a better patient experience. Imagine how a set of principles – a framework – and agreement on the objectives – like the triple aim – could have changed the debate in Congress. But we don’t ever talk about what we want to achieve, instead focusing on only on the steps along the way to a place we haven’t agreed we’re going. I’m ready for a change in how Congress operates and whose voices they listen to.
We have some challenging problems ahead here in Oregon, too. We are not a rich state and when the economy is struggling things are hard all over. Even after a hard fought ballot measure campaign, which has left some strained relationships in its wake, we are not ready to tackle the underlying issues of how we raise revenue and how we pay for public services. This issue did not go away after the ballot measures passed. Yet, when the governor asked that the legislature to examine the rainy day fund and kicker reform, the legislature wouldn’t, perhaps feeling it wasn’t the right time. Oregonians know that times are hard, and if our leaders are willing to be honest with us, we are ready to roll up our sleeves and help come up with creative solutions. We’ve heard this at every community meeting over the past 4 years.
We started with listening to you, allowing you to shape the words and structure of the principles and framework. We’re talking about doing that again in 2010. More news to come on that next month. More than ever, your voice is needed.
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