Fred Gluck: Imagining a Bipartisan, Systematic Approach to Healthcare Reform
By Fred Gluck, TES Contributor
As COVID-19 rivets our attention on health care, all proposed fixes for our health care system – from Medicare for All to a lightly regulated free market model – have the same fatal flaw. They merely tinker with the status quo, a slapdash, piecemeal design that will never meet our needs. Not surprisingly The Commonwealth Fund’s international rankings place the United States last among 11 developed nations in terms of health, despite as much as twice the spending.
Neither Democrats nor Republicans have put forth a credible plan for addressing this unhappy situation. Instead, their internal debates follow diametrically opposed ideological lines emphasizing public insurance for the Democrats and private insurance for the Republicans. Building bipartisan support through the political process is unlikely if not downright impossible.
The way we manage the health of our population was never the outcome of a rigorous system design process. It more or less evolved in fits and starts, and the coronavirus pandemic highlights that we are, and have been, at a crossroads in health care reform. We can either continue with business as usual — ceding responsibility to the politicians — and irrationally hope the political system will somehow find a way; or we can take a different approach.
The coronavirus is a painful wake-up call that should make us realize we urgently need to adopt a bipartisan “moonshot” systems-engineering and project-management approach to the complex and challenging task of fixing our deeply flawed healthcare system.
During Apollo, NASA Administrator James E. Webb took the lead in transforming NASA from a loose collection of research centers to a highly coordinated systems engineering and project management organization capable of orchestrating decisions and dealing with their consequences. As a long-time Washington insider, he was also successful in sustaining bipartisan commitment and delivering the necessary resources.
We need a similar approach for healthcare, where the Department of Health and Human Services (HHS) is responsible for “protecting the health of Americans”. However, it was not designed for urgent action or leading a comprehensive change initiative. HHS oversees a loosely coordinated, very complicated collection of operating entities in federal government, state government and the private sector. There is no central leadership capable of making the necessary decisions and managing the types of major changes required to optimize the way we finance and deliver health care.
We have a desperate need for an independent entity with the political heft and high-level systems engineering and project management capability to drive a comprehensive multi-year design and transition program. That could be solved by creating a National Health Security Authority (NHSA) modeled along the lines of NASA but with Federal Reserve-like status charged with carrying out a comprehensive system design and working with HHS to manage the transition from our current non-system.
The NHSA would work with the President and Congress to specify objectives and essential boundary conditions. At the highest level of abstraction, the objective would be to a bring the health of the entire U.S. population to the top ranks of developed nations and total spending in line with these nations within, at the very outside, the decade. It would emphasize a comprehensive standard level of care for all Americans, maximum use of resources in place and continual reinforcement of bipartisan support.
Real healthcare reform may seem far away and impossible in the politically polarized and stalemated America of 2020. But if we heed the wake-up call of COVID-19 and break the stranglehold of partisan politics, we can break out of the Beltway Box, move on from tinkering and grand schemes like Medicare for All and accomplish the singularly important mission of health care reform.
Fred Gluck led McKinsey and Co. as its global Managing Director from 1988 to 1994. He has also served as lead independent director of HCA, on the board of Amgen and as vice-chairman of the New York Hospital. For a more detailed explanation of how the NHSA could enable us to reach that goal, visit sensiblehealthcarereform.com.