Too little too late?

The Washington post today reports that several stake holders in our healthcare system (the AMA, PhRMA, AHA, AHIP, to name a few) are meeting with President Obama today to discuss their commitment to cost-containment in healthcare (http://www.washingtonpost.com/wp-dyn/content/article/2009/05/10/AR200905100222).  Indeed, to someone who has been an observer of this area it seems a bit disingenuous, albeit a strategically obvious move. I don't know how many readers will remember the multi-million dollar campaign mounted by the same stake holders in the early 1990s during the Clinton administration against the then proposed overhaul of the system (the famous "Harry and Louise" ads were a part of this campaign). The idea was that introducing the kind of regulation into this industry would not only be un-American, but also might lead us onto the path of limited access and rationing.

Interestingly, this was not the first time in American history that a proposal to change how we deliver healthcare engendered such rhetoric. During the Truman administration, in mid-to-late 1940s, there was a strong movement afoot to reform medicine. Framed initially as "compulsory health insurance", it became better known as "socialized medicine", a moniker that to this day brings goose pimples to our necks along with the drab grey images of Communist demonstrations in the Red Square. That campaign was in fact so effective precisely because it implied that, should we pass such legislation, we would become either the Nazi Germany or the Communist Russia, the paragons of un-Americanism. With large amounts of money spent on effective advertising (a little known but affable and convincing actor by the name of Ronald Reagan was featured in many of the ads), the measure was gutted and forgotten until 1993, when similar tactics were once again employed by the opposition.

Now, with a strong Democratic leader in the White House, along with a near-veto-proof majority in Congress, and a staggering deficit, the former nay-sayers are eager for a place around the table. But is this enough? Are they hoping to replace legislative mandates with unenforceable commitments? To be sure, the issue is very complex. Many people and groups bring divergent agendas to the issue. And while I truly believe that there is no fundamentally evil intent to deceive the American people, we need to be wary of these agendas. Since the primary goal of a business is to make money, and since early in our history we chose to allow healthcare to fit a business paradigm, many of the stakeholders meeting with President Obama today will be looking out for their best interests (the AMA for the physicians, PhRMA for the pharmaceutical manufacturers, AHA for hospitals and AHIP for the insurance companies). On the other hand, since the healthcare industry is one of the major employers in this country, at least to some degree their interests overlap with those of the public as a potential engine of economic growth, a particularly relevant issue in this recession. 

So, the President and his team will be walking a tight rope in order to balance industry agenda with the interests of the American people. It would be easy to say that the current efforts of these industry groups are, in fact, too little too late. However, we have an accomplished politician in the White House, who seems to be able to negotiate important compromises without giving away the store. I am hopeful that Obama will make a good faith effort to work with these groups, and that this effort will result in strong legislative action that will create durable and enforceable regulations to ensure sustainable, equitable and high quality healthcare for all.