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Health Care- Crisis or Opportunity

It was the best of times, it was the worst of times.” This opening from Charles Dickens’ A Tale of Two Cities applies as much today to the subject of health care as it did to Dickens’ epic novel.

Perspective is rarely objective. Crisis or opportunity usually depends on which end of the barrel you are staring down. And sometimes – if not often – perspective is hard to achieve. In the United States, we are inundated with so much statistical information, much of it conflicting, from so many reputable sources (Gallup, Louis Harris, Noble Lownees, A. Foster Higgins, Robert Wood Johnson Foundation, U.S. Statistical Abstract) that it is hard to know what to believe.

Our natural inclination is to believe those surveys and statistics that most represent and support our own comfort zones. Those comfort zones rest upon economic foundations poured from our very own – and very personal – education, training, and professional experience. These comfort zones and economic foundations are currently being challenged and assaulted. Today’s health care crisis has replaced yesterday’s Desert Storm crisis, and the crisis of Communism, the S&L crisis of the 1980s, the oil crisis of the 1970s, and the Vietnam crisis of the 1960s.


What do all these crises have in common? And what does it take for something to become a national crisis? Three things: billions of dollars, conflicting opinions, and – the key ingredient – timing. For example, why is the question of the uninsured population an issue today more so than in 1951, when the uninsured population percentage was 44 percent? Could it be we were distracted by the Korean War? Or 1960, when the uninsured population percentage was 28 percent? Could it be we were distracted by Camelot? Even after the passage of Medicare/Medicaid in 1965, the percentage of the uninsured has remained fairly static at 14 percent.

What is different today? Timing! As this is written, the country is enjoying an economic boom. So, there’s an interest in turning our thoughts to other needs . . . and there it is, yet once again: health care. Only this time around, in the still relatively recent wake of the administration’s failed plans for a National Health Insurance Program, we’re seeing a partial resurrection of sorts in the form of title XXI of the Child Health Assistance Program to meet the health needs of an estimated 10 million uninsured children.

Try, try, try again – then try some more – and success will result. Maybe only partial success. But that can, and often does, represent the start of something big. So, you might say – and this time you could be correct – that health care is an issue whose time has come. Yes, we’ve all heard that song before. But when you keep hearing it and hearing it, as from an old familiar score, something is eventually bound to be done and, make no mistake, it will affect all our pockets.

During the 35-year period from 1951 to 1996, our total health care bill has grown from $14 billion to one trillion dollars! One trillion dollars exceeds the total US. military expenditures of World Wars I and II. A. Foster Higgins projects that at our current pace total U.S. health expenditures will surpass $1.6 trillion by the year 2000. That figure will eclipse the total U.S. military outlay for both World Wars, Korea, Vietnam, and Desert Storm by more than $300 million. To paraphrase the late Senator Everett Dirkson (R – IL), “A billion here, a billion there, and pretty soon you are talking about real money.”

The cost of the Child Health Assistance Program? Some $24 billion! The money is earmarked as a block grant for the states to use as they wish. Now, hear this: Even proponents of the program can’t currently verify if there are indeed 10 million children in need of benefits. . . or millions less! What’s going on here? What’s going on is a trillion or so (and climbing) here, a few billion there, etc. An interesting ad ran recently in ‘some insurance trade publication. The question is asked, “Do you know who is responsible for the high cost of health care?” The graphic shows several hands all pointing in different directions. The inference to be drawn is that all parties in the health care arena know who is responsible. .. and it is anyone and everyone other than themselves!

The fact is we are all responsible legislators, regulators, hospitals, physicians, insurers, administrators, marketers, and consumers. However, unless we all face up to our responsibility, we run the risk of losing this historic opportunity to effect social change in a responsible manner. If we want to abdicate this responsibility even more to the federal government, we merely need to stay the course and maintain the status quo.

Our objective here is not to point fingers or lay blame. This is not a zero-sum proposition where one party’s gain comes at another party’s loss. Our objective is to inform, to educate, to initiate dialogue from differing perspectives in the hope that a better understanding of the needs, concerns, hopes, and fears of heretofore adversarial interests can be reached.

The health care industry has often been accused – and often justifiably – of being reactive, not active. But certainly an industry as large as ours, and with so many intelligent and creative minds within, should be capable of at least laying the foundation of an unbiased program that will cure the ills of the healthcare system. If we build it, they – legislators, regulators, hospitals, physicians, and consumers – will come.

Due to the magnitude of this issue, it is going to take a Desert Storm-like mobilization and commitment by both the public and private sectors to do a better job of understanding each other and to find ways to work together to create a win-win relationship. Let us begin.

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