Sunday, July 26, 2009

Waterloo.... or "Mission Accomplished?"

The Disease Management Care Blog likes military history and has a passing familiarity with battlefield analogies. For example, there are ‘Verdun’ (a wasteful stalemate), ‘Thermopylae’ (noble defeat), ‘Gettysburg’ (the turning point), ‘the Bulge’ (holding against overwhelming odds), invading Russia (biting off too much) and ‘Waterloo’ (overreaching leading to disastrous defeat). As readers are aware, the latter term was gleefully used by a Republican U.S. Senator to describe the President’s and his fellow Democrats’ prospects over healthcare reform. Mr. Obama, in turn, has categorically rejected the notion as an example of toxic partisanship.

And so it goes.

The DMCB recalls an old military joke based on the Russia analogy. Just prior to the invasion of the Czar’s Russia, one of Napleon’s Generals was spending the night with a woman of ill repute. In the afterglow of their love making, Monsieur Le General was unable to restrain himself and shared the details of the top secret battle plans. In fact, he kept a map of Europe on him and spread it out over the bed. In hushed excited terms, he described how the French armies would sweep toward Moscow and beyond, bringing even more glory to the Republique. The woman listened in silence, thinking about the obviously different sizes of the countries on the map. When the General paused and asked her what she thought, the woman pointed to small France on the left versus the huge Russia on the right and said ‘Have you shown Napoleon this map?’

While the expanse of healthcare reform could turn out to be more Russia than Waterloo, the DMCB has a better analogy in mind: Bush’s Baghdad and ‘Mission Accomplished.’ Following a superbly executed U.S. military campaign, Iraq’s conquered capital descended into frightening chaos that cost precious American lives and treasure. Of course, Washington D.C.’s ragtag Democrats have little in common with General Schwarzkopf's staff, but passing a healthcare bill is not that dissimilar from the complexity of armoured divisions. What is important is that the Dem's army with considerable legislative firepower has its Baghdad in sight. Odds are, according to the information markets, that bill may pass.

The DMCB takes the longer view. It looks beyond Waterloo and asks what happens if Baghdad falls?

We know what happened in Iraq. While the U.S. Army ‘took’ Baghdad, establishing peaceful representative democracy in the Middle East turned out to be a far more elusive goal. Various tribes, religions, extremists turned out to have far different agendas, making a real mess of things. Will the same scenario happen in a post-Obama U.S. healthcare system? Will providers, insurers, States, regulators, big Pharma, technology manufacturers, the Unions, U.S. businesses really fall into line as predicted/agreed?

Going forward, the healthcare architects in the House, Senate and Administration would be wise to keep this more recent military analogy in mind. Just because a bill passes may not mean they can claim health care inflation has been tamed, that Americans will have credible access to care, that quality will grow, that our life spans will increase or that the mission is accomplished. After passage of a bill, our Commander in Chief may be politically tempted to take credit while standing on the tarmac next to some hospital, only to watch things not go at all according to plan.

No comments: