A Watershed, Not a Waterloo

Abstract

WHEN I WAS first asked to write this commentary for Frontiers of Health Services Management, knowing that I would be contributing with the likes of Emily Friedman, I must admit I was a bit intimidated. But after reflection, I realized that I was able to offer comments on a subject I know all too well-the uninsured and the lack of a comprehensive national public health policy. While I do not profess to be either an economist or an expert on the subject of the uninsured, I do live with this situation every day, as I manage a hospital in the Greater Houston area of Texas and I previously was the chief executive officer at a large hospital in Florida. The problems discussed in these articles are especially acute in both of these states. Hospital executives, and hospitals themselves, are at the center of the public policy debate on the uninsured and of the economic pressures that come to bear in a society that expects perfection, demands access, and requires that care be provided but in essence does not want to pay the bill. Deborah Chollet does an admirable job describing the different options available to provide coverage for those who are uninsured. But after reviewing the options she details, I am struck by the overwhelming feeling that we as a country-and as an industry for that matter-do not yet have the will, nor do the politicians have the mandate, to bring any of these approaches to fruition. That being said, I believe that Chollet has concluded her article correctly. She states that our future system-our solution-to this matter will lie in parallel realms of public and private coverage. It seems improbable that a government-sponsored system could or would be enough to remedy this complex challenge. A public-private approach that includes the best of what each has to offer, coupled with a more seamless and coordinated effort between the two segments, as Chollet suggests, seems more practical, more doable, and certainly more palatable to the industry and our political leaders alike. I would also like to echo Chollet's call for improved efficiencies in the system, through reduction in errors, more homogeneity in treating patients' illnesses, and information sharing among providers and between providers and patients. These improvements will both empower providers and patients and improve their decision making. I would broaden this assertion to also include the potential for significant reduction of the administrative costs of the system. The amount of cost in the system related to the silos that exist among consumers, providers, insurers, and the government is staggering and feeds bureaucracies that add no value, provide no care, and cause endless frustration to patients and hospitals alike. Moreover, we as providers must step up and embrace quality practice and eliminate the waste and inefficiencies that exist in our own delivery systems. And at some point in the not-too-distant future, we must be able to prove to ourselves and to our consumers that we do in fact do the right thing at the right time with the appropriate resources, without fail. Friedman's article describes the collision course on which we find ourselves. I am certain the readers will recognize the dilemma that healthcare leaders face daily: too many want what too few are willing or able to pay for. If we indeed are at a watershed moment in our industry, as Friedman contends, then she has eloquently described the situation that has led to this moment. …