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.

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