The ongoing debate around health care reform offers ample evidence that people still believe in magic elixirs. For years we heard that if only tort reform could be enacted, frivolous lawsuits would vanish, defensive medicine would wane, and the health care system’s cost problems would be solved. If only it were that simple.
Another wondrous potion is competition — most recently found at the center of Rep. Paul Ryan’s proposal to overhaul Medicare. Introduce competition and costs will dramatically fall…or so goes the reasoning. Sen. Joseph Lieberman wants to trim costs by raising the age of eligibility for Medicare from 65 to 67. Yet others advocate that the most money can be saved by extending Medicare to everyone.
Of course we can’t forget everyone’s favorite: WFA — that’s waste, fraud, and abuse for those of you without a Washington, DC acronym decoder ring. Get rid of WFA and all will be solved.
The truth, of course, is that each of these ideas have some merit yet none is truly “the answer” that will cure the system’s financial ills. There are no magic elixirs for cost, quality, or any other shortcoming. The challenges are far too intricate for any single solution to have such miraculous powers. In a complex system, the only thing guaranteed by placing all of one’s chips on a single solution is that one will invoke the special law that no legislature can repeal: the law of unintended consequences. The current quandary of rising costs and unacceptable quality result, in part, from previous well intentioned efforts.
The many issues in health care — affordability, accessibility, quality, an aging population, rapidly evolving technology, shortages of primary care doctors and nurses, and many more — are dynamic and interdependent. When you try to address one, you have an impact on all of the others. Trying to “fix” health care requires multi-dimensional, multi-party problem solving which, at its core, is an exercise in negotiation.
Adversarial negotiation — the theatrical “we’ve got the solution and those other people evil idiots” exercises celebrated in the media — will not yield the answer. What is needed instead is a more collaborative process in which initial agreements (and in our experience agreements outnumber disagreements almost every time) can spawn new ideas conceived together by the stakeholders. It is not “I win, you lose” but rather “When I succeed, you succeed” and vice versa. In Renegotiating Health Care we describe such a process: The Walk in the Woods.
Look, for example, at Kaiser Permanente’s adoption of standard protocols as the default treatment for most adult cancers. Patients get evidence-based care, doctors benefit from the data and experience of the entire system, and costs are reduced as well.
Negotiation skills are going to be as important in clinical prowess and management expertise as we work toward the next generation of health care. The only elixir is to embrace the hard, but rewarding, work of engaging all stakeholders in ways that enable them put their needs on the table, understand the needs of the others, creatively contribute to possible solutions, and arrive at prescriptions that meet their collective needs. There will be magic in the elixir, but it will come from the wisdom and insight of those around the table.