As a leader, one of the most damaging things that you can do in times of crisis is to do NOTHING.  As I have been listening to and reading about the ongoing national healthcare debate, one question keeps running through my mind.
<blockquote>When are we going to stop talking about it ...

and start doing something about it?</blockquote>
At one point in my career, from December of 2006 to December of 2008, I had the honor of serving as the CEO of ASBA, the Arizona Small Business Association, and on the Board of Trustees at NSBA, the National Small Business Association.

As the owner of a small business myself, I had seen the challenges faced by small business owners when it came to the accessibility and affordability of healthcare insurance.  At  the time, it was a personal issue I dealt with and not a major focus of my attention.

Then came my role at ASBA  and a day when solving the healthcare problem, at least for small businesses in the State of Arizona, became MY problem.  This video is a clip from a talk I gave on the topic of Healthcare when ASBA  launched its solution for Arizona Small Businesses in 2008.  It started like this...
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Putting the health back into healthcare in the United States is not a simple problem.  In fact it's complexity is staggering.  Here are just a few of it's components - I know I will miss many more.  Don't pillory me for it.  Instead I encourage you to add to the list in the comments section of this post. (For more information, click the links to articles in each description.)
<h4>Structural issues</h4>
Right or wrong, our current system is is supported as an <a href="http://jkw.typepad.com/corepurpose_joan_koerberw/2009/07/making-cents-of-your-health-insurance-dollar.html">insurance based system</a>.  Healthcare is paid for by Medicare/Medicaid (public insurance) or private insurance in most cases.  For those without adequate coverage, the costs can be financially crippling and their unpaid bills get paid by everyone else in the form of higher premiums as explained in <a href="http://knowledge.wpcarey.asu.edu/article.cfm?articleid=1445">this article</a> from Arizona State University's <a href="http://knowledge.wpcarey.asu.edu">Knowledge@WPCarey</a>.
<h4>Ethical Issues</h4>
What should we do?  Who should we help?  What should we pay for?  What should we not?  The answers to these questions reach into much deeper ethical, moral, and legal discussions on highly volatile issues including aging, illegal immigration, abortion, euthanasia, stem cell research, and the quality and accessibility of care.  An that's just the tip of the iceberg! The study of BioEthics now even has it's own <a href="http://www.bioethics.gov/">Presidential Commission</a>.
<h4>Financial Issues</h4>
If you think this is all about health, think again.  The healthcare crisis in the US is a major economic issue as illustrated in this <a href="http://www.forbes.com/2009/07/02/health-care-costs-opinions-columnists-reform.html">article from Forbes</a> on July 3, 2009.  In this <a href="http://www.cbo.gov/ftpdocs/102xx/doc10297/06-25-LTBO.pdf">report from the Congressional Budget Office</a> total spending on health care in the economy has doubled over the last 30 years to a current level of about 16% of GDP. CBO estimates that this percentage will double again over the next 25 years to 31% of GDP.  Today, it is estimated that as much as 60% of personal bankruptcies in the US are tied to healthcare related issues.  But if we do not get the costs,  and the resultant Federal deficits under control the fall out could be the greatest financial mess the world has ever seen.

Solving the problem will need to address how to find new cost efficiencies in healthcare delivery, behavioral changes among the US population to reduce health risk factors, new protocols for treatment and cost management, and many many more issues.

We will also need to redesign our reimbursement systems.  Today, the set payment schedules for Medicare and Medicaid are below the actual costs the doctors and hospitals incur.  The short fall is then passed along to the costs charged to private insured and private payers  - a practice called <a href="http://content.healthaffairs.org/cgi/reprint/2/2/20.pdf">cost shifting</a>.  But as we have seen, even this has not been enough to keep many medical centers and hospitals financially healthy - see this <a href="http://www.washingtonpost.com/wp-dyn/content/article/2008/07/06/AR2008070602334.html?hpid=topnews">July 7, 2008 article</a> from the Washington Post for a good explanation of the problem and since this was written the problem has only gotten worse.
<h4>Technology Issues</h4>
In recent years, we have looked to technology to solve other problems - it will work for healthcare too, right?  Unfortunately not.  While US healthcare, for those that can afford it, is some of the best in the world, each advancement has a price and contributes to the rising healthcare costs.

E-medical records, a popular topic earlier this year when major funding was allocated as part of the stimulus package by Congress will pay off over time, but not in the immediate future as it carries a high price for implementation.  <a href="http://www.himss.org/content/files/EMRCost-BenefitReality.pdf">This presentation</a> by Michael H. Zaroukian, MD, PhD, FACP of Michigan State University helps break it down.

Break throughs in Pharma and Biotech will help us improve quality of life, aid in early detection, and treatment of chronic diseases.  (A major portion of today's healthcare spend.) But, today's legislation has little to do with funding support for these technologies at they level that will be required to really speed up the process.
<h4>State Sovereignty Issues</h4>
Many of the factors that are driving up the costs of the healthcare system are legislated on a state by state basis.  Congress will have a problem making any real change here without overriding or <a href="http://oversight.house.gov/documents/20060606095331-23055.pdf">preempting</a> many state laws.  These include the costs of <a href="http://advance.uconn.edu/2009/090223/09022302.htm">defensive medicine</a> and <a href="http://www.mpmlc.com/">malpractice insurance costs</a> that will continue to escalate until we reform our tort systems at the state level. In addition, <a href="http://www.cahi.org/cahi_contents/resources/pdf/HealthInsuranceMandates2008.pdf">mandates</a> on a state by state level require that certain care or services be provided and covered.  Each and every one of these items has a cost.  Thus the cost of providing healthcare can fluctuate significantly from state to state.
<h4>Personal Responsibility Issues</h4>
If you have noticed, so far, the focus has been heavily on what 'they' have to do to fix the problem.  But there is another major issue that can not be overlooked - and that is our own personal behaviors.  It has been said that the US has a sick care system, not a health care system.  But the shift from sick care to a health focus is not in the government's hands, it's in ours.  It has been estimated that regular check ups can play a major role in early detection of chronic disease and that early detection leads to major cost savings - not to mention longer lives.  Yet at the same time, a large majority of those of us who have a wellness plan as part of our health insurance don't even use it. Health in the US population did not get a great score on it's report card in 2008 as you can read in this <a href="http://www.time.com/time/specials/packages/article/0,28804,1860289_1860561_1860562,00.html">article from Time</a>.
<h4>Uncertainty Issues.</h4>
And running through it all is  the issue of uncertainty.  None of us know what is going to happen at this point.  Businesses are putting off health insurance decisions and states are in a quandary as to what they should be doing - if they could even pay for it.

Hospitals, doctors, and insurance companies alike are delaying the launch of new programs that could help make a difference because they have yet to learn the new rules of the game.  Basically, progress has stopped!
<h4>The Ugly Truth</h4>
No one piece of Federal legislation will have the magic prescription to solve this problem.  And for all the shouting, the final bill that will be voted on by the House and the Senate does not even exist yet.  Then and if they can get it through Congress this session, it will be an ongoing process for years to structure all the regulations, set up systems, start a never ending process of revisions, and have any lasting effect.

No matter what we do or how the system changes, some will benefit more than others. Some people will pay more, and some will pay less.  New systems will emerge, and others will fail.

But we will never have any improvements if we do not take the first step.  And If we fail to make improvements, our healthcare structure will ultimately fail.  We already  know that the foundation is seriously damaged.

To wrap things up, there is an old fable about a man who claimed he could eat an elephant.  When other's scoffed that it was impossible to do so, he simply shared his strategy...
<blockquote>You do it one bite at a time.</blockquote>
Well today, putting the health back into healthcare is our elephant - and it is well past time we took that first bite.

Thanks for stopping by.  Stay Tuned...
<blockquote>Joan Koerber-Walker</blockquote>
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