Looks like I’m a bit late to the conversation you are having out here. Some great comments and good thinking. Hopefully I can add to the mix a bit.

Two thoughts to add to the conversation:

I like the triangle model. I’ve seen it twice in the past couple of days. Here and in an article I read…..I think it was in Newsweek. It explains the tug of war that takes place in the politics of this space as well as the realities of the multitude of solutions being considered. The triangle explains that you can’t have it all.

The question then becomes where is the balance and collectively how much of what do we want and need. Cost, choice and coverage. I think this is at the core of the current debate and I too believe this will continue to be an evolutionary process and even then not static. A process that will constantly need balance.

The second piece of thinking I’d like to add to the debate is continuing the stream of thought regarding Michael Porter and his thinking on the subject. He recently wrote an article (I think it was in the NE Journal of Medicine but don’t hold me to it) where he talked about the fact that employers can not and should not remove themselves from providing health care.

He differentiated health care by the way from mere health insurance. He called the later the “sick fund” and labeled it as valuable but reactive. He cited the growth of employer sponsored health care in countries with universal coverage as an example. His focus was on the value to the business of keeping people healthier and helping them manage their health….its impact on productivity and the cost of disability to the operations of the business.

He focused on the use of information technology and the customized and predictive information employers can leverage to help employees change their behavior and better manage their health. I’ll see if I can retrieve the article…he does a more better and much more compelling job than I do…..but I found the focus very interesting.

A third thought…. I know I said two but this hit me as I was writing #2. So what should each of the players in the process do now? What actions (if any) should they take? Is sitting still and waiting an option right now?

Look forward to your next installment …

Steve MacGill

I agree with your premise that the industry as been in a state of evolution and will continue to do so. The speed at which change is happening however is certainly accelerating. My perspective, after having been inside many of these nation’s leading organizations, is that leadership for the most part is simply afraid of change or is not equipped for it. The triangle “tug of war” between the providing of care, the payment of care, and the personal expectation of care makes for a very difficult balance. This of course is why some in government feel compelled to step in. I don’t have the solution of course but I do know that leadership at all levels must not be fearful of the unknown and be willing to wade into the depths to continue to improve the system.