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Saturday, September 5, 2009

Fundamentals of the health care wicked problem

The public conversation regarding the myriad of problems associated with delivery of health care boils down to three basic themes. First there is the theme of fairness and entitlement; we have unfairly excluded significant segments of the population of access to services they should be entitled to. Second, we are going to go broke unless we change how health care is paid for. Lastly, health care as it is presently delivered fails to respond to patient wants and needs, even fully insured and financially well off clients.

Viewing the debate within framework the analysis and potential solutions become both clearer and more murky. Fixing one of the two imperatives automatically makes the other more difficult to address. Scaling back on spending likely aggravates the third imperative.

This raises the obvious question, what is the priority? The answer to that question really depends upon who you might ask and is at the heart of the gridlock we have faced for over 20 years. Any broad reaching federal solution likely will impose the priorities of one group (and likely a minority group) on the remainder of the population. How can one reform health care while maintaining sufficient flexibility to ensure the needs and wants of diverse populations (with different needs and wants) will be met into the indefinite future without bankrupting our children?

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