The Next Eight Years

Only a crisis can force the changes that need to be made.

WHAT'S IN STORE for health care in the next eight years? As I write this column, we are less than a month away from electing the nation's next President. I'm not sure it will make any difference who won when it comes to significant health care reform. Nor will it matter whether our new President serves four or eight years.

At my desk I have the 6-pound, 1,342-page Health Security Act that was checked into our library on November 29, 1993. It was, hands down, the most serious stab at major reform and universal coverage ever. Of course, it went down in flames. It was a take no prisoner's effort that ticked off more special interests than almost anything else attempted by any new Administration since WWII. It is a major reason for saying we must be incremental in our move to significant reform and universal coverage.

"Incremental" in my mind is a code word, meaning the continuation of the same confusing, wasteful, frustrating and expensive "tweak it" mentality that is making our physicians, hospitals, nurses and patients paranoid, depressed, angry and near comatose.

Our health care system, especially in California and our region, is in much worse shape than it was eight years ago. While we have seen a growing, and perhaps a majority, consensus on the need for universal health coverage, there is no agreement or leadership on how to do it. Our medical groups and IPAs are in serious financial trouble. There have been hundreds of medical group failures, bankruptcies and hospital closures. The for-profit HMOs have gotten bigger, fatter, fewer and more powerful.

Despite the booming economy, the number of uninsured continues to grow. The Legislature and the Congress seem preoccupied with chasing crooked providers, assuring patient rights and medical record confidentiality, opening the National Data Bank and passing other burdensome regulations.

Meanwhile, we are headed for more of the same and perhaps a real collapse of the system. California, once again, will lead the way down, and perhaps up from the ashes.

What will it take? It's going to have to get worse. Right now, the interests of the HMOs, the physicians, hospitals, purchasers and patients are not aligned. If fact, they conflict with one another. Only a crisis can force the changes that need to be made, and there is a good chance it will occur in the next eight years.

I could tell you what I think needs to happen. And I could try to predict how the crisis will play out locally and in California. But that's not going to get us thinking or whipped up.

So, let's hear from you. Send us your thoughts. Let's see if any of you are reading this. How about hearing from our leaders, nurses, some patients, a politician or HMO executive? Send your thoughts in 250 words or less to info@ssvms.org or by facsimile to 916/452-2690.

bsandberg@ssvms.org