Can't We All Get Along?

John Marcille

Although we all know that change is inevitable and, in health care delivery and financing, highly desired by many stakeholders, most of us prefer evolution to revolution. Revolutions have a habit of being uncontrollable, and most of us want to stay in control as much as we can.

Health care cost inflation is the big issue today, but it shouldn't overshadow quality improvement. Both cost-control and quality improvement have been basics of managed care since the concept took root after President Nixon signed the Health Maintenance Organization (HMO) Act of 1973. If you turn to the last page of the magazine you will see a report on a federal study that sees inflation moderating somewhat. But somewhat may not be good enough for many companies and consumers who have been hit hard with premium and copayment hikes.

As un-American as many people think a single-payer scheme might be, we are starting to hear more about this "solution" to our problem, and I expect interest to grow. But the status quo is powerful; very few who run any sort of profit-making (or fee-collecting) organization in health care will be eager for a single-payer plan.

At the moment, we find that some stakeholders, as reported in Martin Sipkoff's cover story, are combining — aligning incentives was the term not so many years ago — to nudge physicians, hospitals, and other providers toward exploitation of the best-practices models and the outcomes and other data that are being collected and disseminated. At the moment, this seems like an "us vs. them" situation, but it is amazing how we grow to accept what we cannot change. In this case, we're seeing hospitals respond to Leapfrog Group pressure for drug prescribing and delivery safeguards, and doctors agreeing to systems that reward them for meeting certain statistical goals (e.g. retinal exams for diabetes patients).

Read too the provocative interview with Paul Ellwood, MD, now known as the "father of managed care." Not too happy with how managed care has evolved, he and his Jackson Hole group are encouraging some governmental initiatives to restore functionality to the whole system. Dr. Ellwood, too, is not eager for revolution.

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