As health care policy evolved from the ACA through the AHCA and on to its next iteration, I continue wonder how to make sense of the process and the value of the outcome. It is understood that there is a Washington-process of committees; “mark-ups”; votes; etc. It is also understood that there are two political parties deadlocked in their ideologies. Parallel to the Washington process is a relentless proliferation of data from think tanks, lobbyists, and academics that supports positions as it confuses us.
With that said, the following is an outline of how I would like to see heath policy assessed.
- Analyze the health care business model
Health care is a $3.5 trillion business domestically, assuming 19% of our GPD, and approximately $7 trillion globally. An overwhelming number of players, each with its own business model, inhabits this system. Policy makers have to draw boundaries to create a manageable business model. The business model should spell out 1) who is being served; 2) what value are they receiving; 3) is the appropriate talent and resources available to deliver the service; 4) what is the cost structure at play; and 5) how will the costs be paid?
- Examine the reasoning behind the policy
The data explosion leaves us with unexplored talking points. For example, the Kaiser Family Foundation recently published the average annual cost of health care per citizen and created a country-by-country comparison. Should information such as this stand at face value or should there be a deeper probe into the numbers themselves and in the causes for those numbers? Of course, this is too difficult to do, especially in light of all the policy-related data that is generated. So, what do policy makers really know? Is data used to support biases or encourage debate? The later process should temper biases. Yet, decision-making biases are rarely challenged.
- Probe leadership positioning
The leadership role of policy makers must questioned. The activities we see in Washington seem to be about the exercise of authority, not about leadership. True leadership is built on mobilizing people to address tough issues. Health care is one of those tough issues. Policy makers defend positions but no not engage in deliberation that leads to problem solving. We need to face the reality of the health care predicament in order to get to the root of the value proposition offered in the health care business model. It seems to be an impossible task given the poor leadership throughout Washington. Does it need to be this way?
University of St. Thomas Center for Innovation in the Business of Health Care.