This week the Senate Finance Committee continues its work on its healthcare bill. As the intensity of the discussion heats up I would like to offer some recent articles that I thought were insightful and/or informative.

To start I thought both the Washington Post article by Ezra Klein and the Wall Street Journal article “Doubling Down on a Flawed Insurance Model” by John Cogan, Glenn Hubbard and Daniel Kessler were very good at getting at some of the nuts and bolts of the healthcare industry and what drives costs, prices, offerings and behavior. To me the articles are successful at educating, not just advocating.

Then there is the recent article by former Senator Bill Frist of Tennessee (R) in US News & World Report in which he looks at the costs/benefits of a mandate for healthcare insurance and provides a very concrete yet manageable first step for reform. To me, this article is important not so much for a policy he is advocating but for the rational measured approach, the examination of historical experiences, and the transparent review of costs/benefits that he brings to the discussion. It is this type of thinking that I believe is lacking in our politically charged debate.

Finally I would like to offer an editorial by David Brooks in the New York Times. It has nothing to do yet everything with healthcare. He advocates a move away from consumption and towards economic self-restraint. What Brooks identifies is actually one of the root causes I believe of our healthcare system failings. We have an industry of significant consumption but the consumer isn’t tied to the immediate paying of the bill. It is as if someone said I could eat all the chocolate I wanted for a week and not gain weight. (I’d bring chocolate to bed.)

In my Healthcare Letter, I put forth that healthcare reform is much more than “payment” and “coverage” reform. It should be about the transformation of 17% of our economy in a methodical, deliberate way that begins to unwind the interwoven complexities of a system that is expensive and cumbersome but still offers brilliant innovation, life-saving treatments and comfort to many.

I hope these articles help illuminate some of the critical issues we are facing in this transformation. I know they did for me. It seems as if these authors had an opportunity for lucid thought in contrast to the constrained environment in the windowless Senate Finance Committee room.

Yesterday, in my local paper, the Gazette, guest columnists Susan Turney of the Wisconsin Medical Society and David Newby of the Wisconsin State AFL-CIO offered in an opinion piece three issues healthcare reform needs to address: access, cost containment and basic system design. If you read it, there was not much with which to disagree.

But in this fairly benign piece was a key statement that underscores how the current reform process is not tackling the true barriers to cost-effective, superior healthcare. Specifically they say that, “We can control costs if all employers pay fair shares of essential health costs, insurers truly compete and we reward providers for quality care.”  Most notably missing is the patient/consumer and our role.

As my English teacher, Ms. Newberry used to say when I would use the word we inappropriately, “Oakleigh do you consider yourself royalty or do you have fleas? If neither is true would you use the word I.”   While I appreciate what the politicians and leaders of advocacy groups are doing for me, I wish they would structure a greater role for me as the consumer of healthcare.

Much has happened in a month since I wrote Healthcare Letter To Americans. I went to my first Town Hall ever as Americans turned out in record numbers to hear and voice opinions to their elected officials.  President Obama spoke to the nation in an unusual joint session of Congress on September 9th. Senator Baucus released the fifth and final piece of legislation expected from Congress.

I would like to offer these observations about the President’s speech, viewing it as one of the most important indicators for strategies and principles guiding the current reform.

First, I thought it was well drafted and delivered. I appreciate the passion that the President brings to the issue. There was also evidence of moving the conversation to the middle ground. Most importantly it revealed how public opinion had affected the Administration’s strategy.

That said, what I would most importantly like to share is what I was looking for in the speech: an indication for a different direction for reform. What I walked away with was confirmation that the problems and missed opportunities I have identified in Healthcare Letter continue.  Why this conclusion? Here are some of the key statements that continue to show how the current reform process is misguided:

Statement #1 “I am not the first President to take up this cause, but I am determined to be the last.”

I appreciate the passion and persistence but believe it is unwise to think in such a narrow political timeline.  Instead I have articulated a viewpoint of transformation that involves everyone from consumers, doctors, hospitals, researchers, regulators, and legislators, over time. In the end, I go back to my argument in Healthcare Letter that making healthcare reform a once-in-a-life time, this-is-bigger-than-all-of-us, rise-to-the-occasion type of event is setting it up to fail. Do the opposite; break it down into manageable deliverable pieces.

Statement #2 “I will not waste time with those who have made the calculation that it’s better politics to kill this plan than improve it.”

What if someone showed there was a better way to do this outside of the current legislation? If this is too important too fail, let’s call out the big elephant in the room – that we might be better off starting this over. I go to a lesson learned in economics. Sunk costs are just that – sunk costs. The time we have invested so far in producing healthcare reform legislation should not impact the decision to start over if that is the best course going forward.

Statement #3: “While there remain some significant details to be ironed out, I believe a broad consensus exists for the aspects of the plan I just outlined…”

I wish there was broad consensus but believe just the opposite is happening. The more people learn about the potential impact of the reform as laid out in the current bills, their anxiety increases.  Interestingly in a USA Today poll this week, well over a majority of Americans didn’t believe that what the Administration is proposing will actually improve our healthcare situation, even if they support the plan.

Statement #4: “To my progressive friends, I would remind you that for decades, the driving idea behind reform has been to end insurance company abuses and make coverage affordable for those without it.”

Having worked in healthcare for over 20 years, I know we are not in the current situation we are today just because there was insurance abuse. By making the insurance industry the focus of concern and even vilification, we have only cheated ourselves of the opportunity of true reform. In fact what we should be working on is the creating the environment and foundation for a healthcare industry and consumer transformation, not creating scapegoats. That has had dangerous consequences throughout history

Statement #5 “So let me set the record straight. My guiding principle is, and always has been, that consumers do better when there is choice and competition.”

While I appreciate and agree with the statement, it sets a tone of protector versus empowerment. The stronger statement to me is that consumer power with education and information will create choice and competition. If someone else tries to do it for us, choices are made on our behalf that might not be in our best interests. What if the statement read something like this: I believe that above all else healthcare should be patient/consumer driven where the individual feels control over the financing and provision of the healthcare they receive and takes a leading role in the management of their care and well-being. Okay, now I am listening.

It has been my goal in writing Healthcare Letter to Americans: Is There Another Way? to avoid falling prey to political lines and to propose a new way of thinking about healthcare reform. In listening to our President’s speech, I walked away with the conclusion that political lessons had been learned but that the fundamental reform process was still fundamentally flawed.

If this analysis of the speech leaves you pessimistic about innovative reform, don’t be. On the contrary, I am optimist. The fact that the speech was made at all is a huge testimony to the power of the individual American voice. In fact what happened in August took me back to the founding of our nation where the local pub was the political gathering place to hear and debate current events. In 1776 Thomas Paine wrote Common Sense, articulating in plain language why we should have independence from Britain. In August 2009, the healthcare conversation left D.C., and it improved. It is in our power to continue that and affect our political leaders views.

It has been about a month since I posted Healthcare Letter on the web. I have been asked by others to recommend articles that I believe help improve our understanding of how the healthcare system works and therefore identify needed components of beneficial reform. Knowing the volume of material, most of it very good, I want to start small by recommending two pieces:

How American Healthcare Killed My Father by David Goldhill appearing in the Atlantic September 2009

Why do I recommend it? It is from an outside Beltway perspective, it is extremely thought provoking and daring, and it holds important insight into how healthcare works from the view of the patient/family. It is a Must Read in my mind. The length is approximately twice that of Healthcare Letter but it is well worth the investment of time.

On the lighter but not less important, I offer an article that appeared in the Wall Street Journal on August 8^th, 2009.

Man vs. Mutt by a British Physician Theodore Dalrymple, Wall Street Journal

With the seriousness of debate I truly appreciated his sense of humor coupled with important observations and opinions. I will continue to post articles so look to the bottom right side of home page.