Sunday, September 6, 2009

Ronald Reagan used to say that “status quo” is Latin for “the mess that we’re in.”

Well, for too many working Americans and their families, the health care status quo is, indeed, a real mess. The “value gap” between what we spend on care and what we get in return is a fundamental cause of America’s health care (and economic) crisis.

We spend twice as much per person on health care than any other advanced nation in the world. But we don’t deliver the quality of care, patient outcomes, improvements in public health and longer life spans as do many other countries. Meanwhile, at least 15 percent of Americans are uninsured — about 46 million people, which is more than the combined populations of 24 states plus the District of Columbia. And many people with insurance are scared they’ll lose it.

Delaying action makes the problem worse. A recent Robert Wood Johnson Foundation study by the Urban Institute shows that if the system is not reformed, within 10 years the cost to American businesses for their workers’ health care could double.

The number of uninsured Americans could reach almost 66 million. Individual and family spending on health care would jump 46 percent to 68 percent, with middle-class families hit hardest.

The consequences would be blind to politics and felt by Democrats, Republicans and independents alike. The only universal thing to come from a lack of reform would be the pain.

This is a true mess, but how do we clean it up? Many of us have our “fix” of first choice that we prefer over all others: tax credits, public programs, business mandates, individual mandates, a combination of some or all of these options or a completely public program such as Canada’s.

But every time the country gets serious about changing the status quo, too many of us stick to our fix of first choice, and we refuse to acknowledge the need for compromise. The only consensus we reach is that the status quo — the mess we are in — is the default choice for all.

Both of us have spent decades working on improving health care and encouraging bipartisan solutions. Whether serving as governor of our nation’s most densely populated state, serving individual patients as a physician or in leading the largest health philanthropy in the country, we know that compromise and consensus are not only possible but also achievable.

It’s not our role as philanthropists to tell lawmakers how to do it. But it is our job to guide the discussion toward common ground.

Our leaders must set aside their preconceived notions and work together in the public’s best interest. They must rise above partisanship, reject ideological rigidity and embrace compromise as a first choice, not as a last resort.

This may sound idealistic, but there is no responsible reason for not acting. Years of research, policy development and experimentation tell us that mechanisms for comprehensive, sustainable reform are neither mysterious nor beyond our reach. Much of the policy work is already completed, the fiscal implications already forecast. The tools are already on the table.

Many acceptable, bipartisan approaches have already been hammered out and discussed. We recently saw a great model of how bipartisanship could play out on health reform if the players are willing. This summer, former Senate Majority Leaders Howard Baker, Bob Dole and Tom Daschle released a report outlining their vision for a bipartisan approach to health reform. It includes compromises that would achieve a health reform plan that is budget-neutral, saves costs, improves quality and ensures that all Americans have affordable health-insurance coverage. Agree or disagree with their plan, their work demonstrates there is a viable bipartisan path to reform when leaders are willing to put personal ideologies aside and work together to move us forward.

What matters most to Americans is knowing that they have the opportunity to lead healthy lives, that health care will be available when they need it and that they get the best quality and value for every dollar that is spent on that health care.

We can do this and do it best if as a nation we sustain a bipartisan will to act, cultivate the support of an informed public and maintain a collaborative, inclusive climate for agreement and action. A bit of bravery is important, too.

Any and all profiles in courage are invited to declare their intentions sooner rather than later. Accepting the status quo and doing nothing is not a viable alternative. The consequences of inaction are far too serious for the health of our citizens and the health of our nation.

Thomas H. Kean is chairman of the board of trustees of the Robert Wood Johnson Foundation. He served as Republican governor of New Jersey in 1982-90. Dr. Risa Lavizzo-Mourey is president and chief executive officer of the Foundation.

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