The Occasional Consideration - 6/24/20

Periodic Meanderings and Ideas Deemed Important by the Author… 

From Listening to Hearing to Learn and Act – So much has happened since my last report in May – so much so that it’s a bit difficult to figure out where to start.  This blog is about health and healthcare so it makes sense that the “health” of everyone should be a concern for all of us in the health care field. So, here goes…

First, it appears to me that we are moving to a new era. Father Richard Rohr from the Center for Action and Contemplation refers to it a “liminal” time derived from the Latin word “Limen”, meaning “threshold” where we pass from one era to another – and, as we enter a period of protracted uncertainty. We’ve had other periods like this in history. Consider the shift from living as hunter-gatherers to living in tribes or small groups. Having been involved in the formation of many groups over the years, I’m sure that for many such groups there was lots of consternation and struggles when it came time to figure out who was going to be the leader. Another example is the Industrial Revolution which extended over a period of about 90+ years. And, now, we are at the formative stages of the Digital Revolution. We are going from a world where societies have placed artificial lines in the sand and dirt to an interconnected world where boundaries are not so clear at all.  And, given the connectivity that exists as a result of the Digital Revolution – it seems to me that as a people, as a society, as a global community we are moving from an all-about-me mentality slowly toward an all-about-us way of thinking. Now, if that is the case, we clearly need to be thinking about the needs of all of us – not just some of us – as we move through this passage to a new state of being.

It is within this context as we move through “Our Liminal Time” that essential requirements will necessarily percolate to the top.  The first requirement is for us to LISTEN to one another – all reasonable perspectives, all reasonable considerations and all reasonable solutions. Embedded within that notion is a very robust conversation around what is “reasonable”. From my perspective “reasonable” will percolate up and be distilled through societal conversation. The second requirement is for all of us to HEAR what we are saying. Essentially, I’m arguing that we need to be TALKING TOGETHER so that we can create an environment or culture of togetherness. Once we accomplish this objective, there are two more essential requirements. We need to LEARN from the moment. In fact, the argument can be made that we will have no “learning” if we will have no “finding”.  Then, the final requirement comes into play – and, that is ACTION

These thoughts need to be at the forefront of our conversations in the healthcare community as we grapple with racism, disparities, police violence and other considerations that impact the health of the people.  For example, there have been many editorial pieces and scholarly articles on racism over the years which highlight the intolerable differences in care delivery, access, treatment and a host of other considerations. I raise the issue of racism because it is clearly front of mind for many of us AND, most importantly, the requirements I’ve outlined above have not occurred in a sufficiently robust manner by those of us in leadership roles in the healthcare community. We’ve listened – sometimes. We’ve heard – on occasion. We’ve learned and documented but the final requirement has not been front and center. ACTION has not occurred. 

And, ACTION will not occur by simply reading this editorial consideration. It will require all of us to “do” something. So, I encourage all of you to be on the alert to potential avenues for how you can make a difference. Whether it’s in your department, across your organization, in your community, throughout society or by making changes in attitude, in programs, in policy, in funding – we each need to do our part for creating and fostering ACTION to solve the problem of racism. You will not be alone if you decide to pick up the mantle of change. Think about it.

Our new evolving society requires this conversation if we are going to be successful in creating an “all-about-us” mentality. And, it’s clear that our society does not end at the edge of the Rio Grande River, the Atlantic or Pacific Ocean, or the Great Lakes region or the vast prairie line in North America. If we want to retain our position as the shining beacon on a hill (NOTE the change from “city” to “beacon” in my reference) – now is the time to step forward by cleaning our own house and showing the world what “us” is all about.  Health care is not a sideline consideration. It is central to the question and the resolution of the issues we’ve allowed to fester for far too many decades…

Mark My Word – When Congress passed the $1.8 trillion package as a stimulus to help the economy stay afloat as a result of the current pandemic crisis, I was truly amazed.  It was more than double the size of the stimulus package passed when the economy collapsed in 2009 and almost as large as the entire 2019 Federal revenue generated by the nation (= $3.5 trillion). Where did all of the new money come from?  You guessed it – we borrowed it!  Now, I’ll be the first to say that this was a good decision on the part of Congress. Without their intervention, the nation would have gone into total hibernation which would have been bad not only for the nation but also the global community. So, the critical question that the Heritage Foundation recently asked is: Where do we go from here?

If one takes a hard look at the federal budget there are not a lot of places that politicians – who are prone to think of getting elected – can turn. The proverbial cookie jar is empty and only crumbs are available for distribution. We will clearly need a broader solution in the coming months and years. My prediction is: HEALTH CARE WILL BE FRONT AND CENTER AS THE MAJOR TARGET FOR FINDING REVENUE THAT CAN BE REUSED TO PAY FOR THE LOOMING DEFICITS. Health spending in the U.S. has continued to increase at a rate far faster than the economy or, about 4.6% (2018) to an unprecedented level of $3.6 trillion which is equivalent to $11,172 per person. There is no other broad area of the U.S. economy that has experienced such growth with much of it at the expense of the federal, state and local governments.

Now, I’m not advocating a slash and burn approach to health care. Far from it. We need a robust Medicare program. Medicaid is essential – especially given the magnitude of stress we are seeing with state budgets which makes the federal budget deficit pale in comparison in some states. Social Security is a benefit that is an expectation by society – among all age groups. Right there you have one-half of the federal budget.  Reducing funds for highways, bridges and infrastructure does not make sense based on many studies which show that the aging of our infrastructure will incapacitate the U.S. economy if something is not done soon. We could turn to the Pentagon but in the scope of things we are looking at nickels and dimes not dollars. Education is an absolute requirement if we want to be a leading nation (some of us would like to reclaim that title). And, that pretty much does it for areas where funds might be available. Which takes us back to health care…

I predict that we are moving toward a robust, spirited and radical conversation about moving health care from a fee-for-service (If-I-do-something-to-you-I-get-paid-for-doing-it) mentality to a value-based care delivery model (If-I-keep-you-healthy-and-prove-it-I-get-paid-for-doing-it). We’ve been tinkering around the edges and some regions of the country are moving more rapidly in this direction. But, just like the COVID-19 pandemic changed everything about how and where we eat, transportation requirements, what we wear and the like – so the deficit will push our policymakers in the direction of rapid change. The most reasonable solution on the horizon is value-based care. It’s a game changer and while it has been slow in coming – I predict that within five (5) years, the nation will have either radically moved toward value-based care or we will have nationalized the care delivery approach. There will be resistance on both sides but I believe many players will clearly be inclined to move toward such a model.  Medicare-for-All has been touted at the approach by some. It proposes placing the care delivery financing into the Medicare model. My approach is a CARE-for-All model which fully embraces value-based care delivery. For a copy of the white paper outlining this approach – send a note to This email address is being protected from spambots. You need JavaScript enabled to view it..  To bring closure on this perspective, I’ll quote the Heritage Foundation who stated unequivocally in their analysis mentioned above, the following point: “The stakes are high, with the prosperity of current and future generations hanging in the balance.”

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