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National Health Care Policy: Key To ReformAmericans are now hearing discussion of a publicly funded health insurance plan as an alternative to private health insurance. Such a plan would represent an entirely new relationship between government and the health insurance industry. This could represent an efficient partnership with lower costs and improved outcomes. Or it could collapse into the nation’s costliest entitlement program with long waiting times and no improvements in outcomes. A lot depends on this partnership. And partnerships depend on enforceable contracts. Last month I visited with thoughtful men who have held executive and mid-level management positions in health care industries. Each agreed with the following: (1) Government is capricious in its payment structure and enrollment regulations. (2) Simply spending money on information technology (IT), encouraging best practices and medical homes, implementing tobacco taxes, and so on are insufficient measures. (3) Insurers’ hostility toward a public/private relationship is not about the inability of the private sector to compete with a government plan; it is about government’s changing the rules on a whim and not being a reliable partner. Therefore, the need for a national health care policy. No true partnership survives when one partner capriciously alters the rules. Well-meaning insurers do want health reform, but they need clear rules to support their attempts. Just as all of U.S. law has a reference point—the Constitution—health care contracts at every level need a similar reference point—a national health care policy. One person volunteered this analogy: "This system had better go the distance right from launch; there’ll be no changing the O-ring at 500 feet." The analogy is a fair one. The national health care policy—the navigation system—must be in place from lift-off, or the ensuing explosion will become fodder for legend.
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