Health Care Reform Needed but Comes Hard

Health care reform comes hard because we didn't get to where we are by accident. That's according to Steven Schroeder, MD, Distinguished Professor of Health and Health Care at the University of California - San Francisco and former president and CEO of the Robert Wood Johnson Foundation.

Dr. Schroeder spoke before more than 200 people at the 14th Annual Flanigan Lecture on July 31, 2008, at St. Joseph Medical Center in Kansas City, MO.

Dr. Schroeder said with health care now representing 16 percent of America's gross domestic product, a lot of people have a vested interest in keeping things as they are. "It's not just the cost of care," he said, "but many people - doctors, nurses, administrators - are paid quite well to deliver that care."

"We have a tendency to look for painless, quick fixes like an electronic medical record or pay for performance," Dr. Schroeder said. "Politicians are particularly quick to pander in this regard, and that's upsetting." Dr. Schroeder says we are also reluctant to take on the involved sectors in healthcare. "Pharma, device manufacturers, the insurance industry, hospitals, doctors, unions - all have powerful lobbies in Washington and in state capitals," he said.

There's also an economic Catch 22 to health insurance reform. "When the economy is prosperous and unemployment low, the middle class feels secure about health insurance," said Dr. Schroeder. "When the economy goes bad and people lose jobs and healthcare, there is not enough money to pay for expanded coverage."

With all of these factors in play, Dr. Schroeder pointed to four pathways to resolution:

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• Charismatic president pushes legislation
• Economic depression mobilizes middle class
• Business asks for help
• The medical profession mobilizes

Keeping things as they are is not an option. "We have a very cruel health care policy," said Dr. Schroeder. "We say to a lot of poor people, 'Tough! Get charity care, wait a long time, be sicker.' We'll accept that because we are afraid of the alternatives."

"I think if Americans understand that we may be more eager to change things."