Under the Lense

Driven to Distraction


It used to be that perfect was the enemy of the good, but now it may be the case that focus is that foe. The Supreme Court’s Affordable Care Act ruling is imminent, which could make it possible to stop driving down the road of system change with one foot on the brake while the other presses the accelerator. Possible, but not likely, because it will be quite difficult if not impossible to disengage from the political battle and surrounding media coverage that will consume the airwaves and internet regardless of what the court has to say.

There is important work to be done that requires us to keep our eyes on the road to better health and health care, but we’ve routinely preferred congregating around the media circus and rearranging the Titanic’s deck chairs instead. We’re up for the fight to resist change, but not so keen on the challenge of pursuing focused pathways to a better future.

When the ruling hits, watch out. Republicans’ “repeal and replace” placards are already at the printers, ready to roll. Democrats are also digging in, pointing to the law’s “ironclad constitutionality.” Everyone not covered by Congress’ own generous health benefits are driven by their individual health and health care status. The relatively healthy, employer-based insurance crowd looks abstractly at the issue even though they’re keenly frustrated by the costs and quality of any given episode of care. People who’ve either just gained system access or have been pushed off over the last several years are ready to kick off protests and press conferences once they see whether there will or will not be an on-ramp for them – today, in 2014, or ever. Seniors who just got their Medicare prescription donut hole covered want to be sure that “you keep your government hands off my Medicare.” System insiders – in places like hospitals, insurance companies and medical device manufacturers – acknowledge that avoiding an unsustainable future is paramount, and doing so requires complete attention, disruptive innovation and fundamental shifts. All of these people and more are likely to be trotted out in the coming weeks as the ruling comes down. In the end, if history is any guide, another bout of political wrangling isn’t likely to quickly or effectively produce much.

Watch all the compelling TV and read all of the blog-based screeds that your heart desires, but don’t forget this context:

  • 87 percent of Americans think health care costs are a serious problem.*
  • 57 percent of Americans think health care quality is a serious problem.*
  • The World Health Organization ranks the US health system 37th among 191 countries, just ahead of Slovenia and Cuba despite being number one in health care expenditures.

(*Source: Robert Wood Johnson Foundation/National Public Radio/Harvard School of Public Health “Sick in America” survey, March 2012)

In just about any other realm such numbers would constitute a crisis requiring immediate attention, but somehow in health care it warrants a debate along ideological lines. We are currently participants in a supreme distraction.

The Roman Empire’s “bread and circuses” approach hinged on the premise that almost anything goes as long as the people have food in their bellies and some form of entertainment to distract them. Rome offered up gladiators and chariot races. We have football and NASCAR, plus reality TV and endless debate about health care reform – and that’s before we get to the quality of our food. Given how things worked out in Rome, we’d suggest moving away from distraction and on to the work of making lives better.

Not too long ago a group of leaders urged the country to “stay the course.” It’s not clear those words were more than a slogan then. Applied to the context of continuing a value-based makeover of the health care system, regardless of how the court rules and without further wrangling, those words make perfect sense today.

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