Wednesday, February 25, 2009

Will Obama's Healthcare Reform Be His Boston Tea Party?

Did you watch Obama’s speech last night? The Disease Management Care Blog did and couldn't discern just what the next steps are going to be when it comes to healthcare reform. It has, however, watched many other past local and national politicians square off on the issue with the same grim determination. The DMCB wishes our President good luck and would like, as bloggers are wont to do, offer some unsolicited and unheard advice.

In the winter of 1773, the British Crown made an eminently rational determination. Since the American Colony’s French and Indian Wars had cost the royal treasury dearly, a special tax was called for. As we all know, a citizen-group in Massachusetts disagreed and held what has been come to be known as the Boston Tea Party.

Fast forward to 2009 and check out this videotape showing a vociferous bunch of Chicago Mercantile Exchange floor traders reacting to the skeptical commentary of a CNBC broadcaster. You’d think these guys should be able to discern the rationale behind the mortgage bailout. As the DMCB understands it, the mortgage mess is torpedoing banks, locking up credit markets, depressing home values and wrecking neighborhoods. Tapping the US Treasury to fix it is also arguably fair and rational. These Chicago traders apparently disagree.

While it cannot judge the merits of the bailout, the reaction of these smart businessmen reminds the DMCB of its own past Tea Party. Yes, we thought that we had a wonderful disease management program destined to improve patient care, reduce physician workload and increase provider income. We spoke to local Chief Medical Officers and VPs and secured their input and buy-in. It was then rolled out in a series of meetings, e-mails and formal presentations. Many physician-colleagues, after listening carefully, told the DMCB to take a hike. Others said nothing, returned to their clinics and turned to both active and passive resistance.

So what’s the lesson? Even if an initiative is 1) needed, fair, rational and well designed, 2) rolled out with an abundance of marketing and education and 3) is directly tied to the self-interest of all involved, everyman Bostonians, Chicago traders and physicians are more than capable of coming up with opinions that are 180° contrary to those of the leaders and experts. Physicians who believe in the merits of one-on-one patient care, based on independent professionalism and scientific judgment may find ‘electronic records,’ ‘team based care,’ ‘populations,’ ‘pay for performance’ and ‘bundling’ to be wanting. As one very bright but oppositional physician explained to the DMCB, he didn’t need any more education. He got it. Want he wanted was to be left alone.

The DMCB also learned something else. The resistance of the physicians wasn’t a function of narrow economic self-interest, intellectual inertia, lack of knowledge or professional dysfunction. They had their own vision, paradigms, ideals, thoughts and opinions. They were being reasonable. Given the circumstances, who can be surprised that the docs concluded that it was their patriotic duty to resist?

In response, we went back to the drawing boards. We addressed some of the concerns, ignored others and set up work-arounds when physician cooperation wasn’t absolutely necessary. We then moved forward and counted on a track record of success to convince the nay-sayers. It took a lot of time and a lot of work.

Fast forward again to the promised release of the Obama Administration healthcare reform proposals. Even if the plan is expertly contrived, even if organized medicine groups’ leaders are supportive, and even if economic self-interest is at stake, the DMCB will not be surprised if a significant number of physicians resist.

The Advice? Don't let healthcare reform provoke a Boston Tea Party. The last time that happened, things really turned upside down.

The DMCB recommends that the Obama Administration recognize that many mainstream physicians will have deep concerns. It should resist ascribing it to unawareness, irrationality, selfishness, the lack of outreach or poor planning. Think King George III.

The DMCB also suggests that if the resistance is significant, the success of healthcare reform may hinge on Washington DC’s ability to adjust and adapt. Avoid being mainframe. Think the Yes We Can Campaign.

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