Where Is Physician Leadership on Reform?

Brian Klepper


In recent months, doctors have faced dramatic Medicare cuts.[1] It is unclear whether these cuts will be realized this budget year. However, physicians should make no mistake: It's not if, but when. The Medicare discussion is only leading the edge of an inundation of healthcare cuts.

Over the last 5 years, premiums -- in which healthcare costs converge from the entirety of the continuum -- have risen 5.5 times as fast as general inflation, 4 times as fast as workers' earnings,[2] and 2.3 times as fast as business income growth.[3] Starbucks' Howard Schultz, a committed proponent of generous health benefits, recently told lawmakers that he spends more on healthcare than on coffee, a situation that he termed "completely nonsustainable.[4]"

He's right. Unrelenting healthcare costs will trump every business' profitability and competitiveness, independent of its philosophy. So business is retreating. Fewer than 45% of private sector jobs have health benefits. That number is dropping approximately 5% per year.[5]

Publicly financed programs will recede, too. Medicare, Medicaid, employee/retiree health, public health, and prison health are among the government's biggest growth line items. Expect lawmakers and administrators to slash these areas.

With the considerable human implications aside, these economics are profound. As skyrocketing costs price individuals, corporations, and governments out of every form of coverage, the financing reductions could destabilize the healthcare marketplace.

However, the damage would cascade. At one seventh of the economy and one eleventh of the nation's jobs, healthcare's disruption would affect every sector, threatening the national economic security.

The changes that are necessary to stabilize American healthcare extend to every part of the system -- how we manage quality and cost in the supply, delivery, and financing of care. So far, the nation has had no leadership on this crisis. With the awareness that change will compromise profitability, the highly fragmented healthcare industry -- physicians included -- continues to practice groupthink in sector-based silos, advocating on issues that are momentarily important to them but resisting meaningful longer-term enterprise-wide reforms. Meanwhile, Congress is beholden to healthcare's many powerful interests, dominated by ideologic rather than structural analyses of healthcare's dynamics, and seemingly paralyzed by the problem's complexity.

Because healthcare's power structure is so broadly distributed across industry sectors -- manufacturers, suppliers, institutional providers, physicians, health plans, and employers -- this impending disaster demands collaborative leadership.

The financial underpinnings of America's mainstream healthcare enterprise are rapidly deteriorating. With many of my colleagues, I believe that the deep goals of any major healthcare reform effort are health system stability and sustainability. If America's physicians are to lead the way or, for that matter, participate in discussions about reforms, then they must view the problems structurally and rise above their special interest to advocate for the common interest, finding the narrow common ground with other influential groups in the change process.

Mobilizing healthcare's many powerful groups, doctors could pressure Congress to rapidly implement the standards, transparency, performance incentives, and other disciplines that are predicates to getting cost and quality under control, and that other progressive industries already take for granted.

If America's physicians -- individually and within your professional societies -- truly desire a stable and sustainable healthcare marketplace that once again serves the common interest, then you must provide the collaborative leadership for substantive changes that align the interests of health industry players, the patients who they serve, and those who pay for care. Only then -- if the common interest is stable once more -- can the market again favor physicians' interests.



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