Common Ground, Common Good, Common Sense

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Common Ground, Common Good, Common Sense

• A Process for Developing Health Care Reform
• Bob Van Oosterhout
• MidMichigan Health Park, Houghton Lake Michigan
• Email bob.vanoosterhout_at_midmichiganhs.org
• For additional information visit
  bobvanoosterhout.com

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How Do We Get There ? (in Spite ofThese
Obstacles to Reform)

• Political attitudes have become more rigid and
  resistant to change (Lee Atwaters concept)
• The Health Care System is highly complex
  solutions are complicated and difficult to
  explain
• The public has limited information and many
  misperceptions about many aspects of the system
• There are widely diverse opinions and a broad
  range of competing self-interests for different
  components of reform
• It is easier to make a case and mobilize support
  for doing nothing (e.g. 1992)
• Funding is a huge obstacle at least in the near
  future

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The Market Cannot Provide Quality Health Care To
All

• Market
• Value neutral
• Prone to manipulation
• Adversarial, competitive
• Profit-centered
• Long-term equilibrium
• Promotion/marketing
• Some will lose
• Survival of the fittest

• Health Care
• Value based
• Stability, equal access
• Cooperative
• Outcome-centered
• Short-term needs
• Evaluation/accountability
• Basic human right
• Health for all

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A Process Based on a Community Organizing and
Empowerment Perspective

• The most difficult issues are best resolved with
  broad-based input and responsibility
• HTC view Disadvantaged people are a resource to
  be tapped, not a problem to be solved
• Empowerment involves working with rather than
  for people

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Advocate Bottom-Up Instead of Top-Down Planning

• Top Down
• Limited perspective
• Based on assumptions
• Exclusive
• Linear, objective
• Fixed solutions
• Can miss critical issues and components
• Results in political infighting

• Bottom-Up
• Broad perspective
• Based on experience
• Inclusive
• Multi-faceted
• Adaptable/responsive
• In touch with critical issues and components
• Develops consensus which prevents political
  infighting

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Confronting Obstacles to Health Care Reform

• Solution
• Common Ground
• work together
• Common Good
• for the good of all
• Common Sense
• shared vision, open minded discussion,
  reasonable, thoughtful, creative

• Obstacles
• Ego -Focus on self before others
• Greed Addiction to accumulation
• Rigidity Certain, righteous, competitive

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Common Ground requiresdevelopment of a shared
perspective, equal input and involvement of all
stakeholders, access to clear accurate
information, and shared responsibility.Common
Good involvescommitment to developing the
potential of each person/stakeholder to serve the
best interests of all.Common Sense includes
openness to input, respect for truth,
receptivity, adaptability, perceptual
flexibility, accountability, and responsibility.
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Components of Effective Planning

• Common Ground - Widely disseminated clear and
  accurate information, broad-based input, and
  shared responsibility and investment
• Common Good - Clear values, principles and
  priorities that form a screen for all
  decision-making
• Common Sense - Commitment to what works
  feedback, adaptability, accountability

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Components of Proposed Planning Process

• Bipartisan planning commission to oversee process
• National Conversation on Healthcare (1) Clear
  accurate widely disseminated information (2)
  National Town Hall meetings to discern and
  prioritize needs, concerns, values, principles
  and priorities that become a screen for future
  deliberation also review and provide feedback on
  proposals
• Stakeholder meetings with peers to identify
  options and opportunities and review proposals
• Planning teams (3-5, later reduced to 2-3) made
  up of representatives of each stakeholder group
• Carefully monitored planning process where
  commitment to truth and prioritized needs,
  concerns, values, principles and priorities serve
  as screen for discussion and decision making.
• Multi-level review process
• Final plan chosen from 2-3 options
• Map for transition from current system to
  quality, affordable health care for all

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Outline of Planning Process

1. Appoint a Bi-Partisan Commission to oversee and
   implement process
2. Conduct comprehensive system evaluation
3. Develop strategies and systems that insure truth
   and balance in all discussions related to health
   care reform
4. Develop broad based system for disseminating
   information about health care systems to the
   public
5. Train facilitators to insure honest and
   reasonable discussion in Town Hall meetings,
   Stakeholder Groups and Planning Team meetings.

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• 2. Begin a National Conversation about health
  care by disseminating information to the public
  in series of two-hour programs (similar in format
  to Frontline or An Inconvenient Truth) over a
  period of three to six months. Each session
  followed by polls and opportunities for public
  input/discussion online, in community settings,
  college forums etc.

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Possible Components of National Conversation on
Health Care

1. How good and bad decisions are made
2. Identifying obstacles to effective decision
   making
3. Basic Principles of effective decision making
4. How advertising misleads / How lobbying works
5. Overview of health care system strengths and
   weaknesses
6. Where the money goes / costs that dont
   contribute to care
7. Effects of current system on various stakeholders
   (who profits, who suffers)
8. Inefficiencies in current system
9. Communication/Data portability
10. Fragmentation
11. Billing
12. Lack of effective evaluation process
13. Review systems in other countries

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3. Continuing the Conversation National Town
Hall meetings (online/community settings/
videoconferences etc.)

1. List concerns
2. Identify and discuss needs, values and principles
   of ideal system
3. Discuss and rate financing options

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• Commission disseminates summary of issues,
  principles and values from National Town Hall
  Meetings
• Second set of National Town Hall Meetings
• Review
• Discuss
• Prioritize values, principles, components

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Examples of Possible Results of Town Hall Meetings
Values Principles Priorities Ideas
Shared responsibility for costs Single simplified records and billing system with built-in accountability and quality improvement Who Children, parents and those who contribute to health, safety and well-being of citizens are covered first Create a simple universal form to update symptoms and list concerns prior to medical visits
Individuals are responsible for their own health Single simplified records and billing system with built-in accountability and quality improvement Who Children, parents and those who contribute to health, safety and well-being of citizens are covered first Create a simple universal form to update symptoms and list concerns prior to medical visits
Simple, clear, transportable (easy information sharing) Integrated system of universal care within funding limitations What 1st Health maintenance and early detection Infectious diseases emergency care end of life care Last terminal dx in aged, cosmetic care Low-cost system to fairly deal with provider error
Accountability and ongoing quality improvement Costs to consumers based on healthy lifestyle and ability to pay What 1st Health maintenance and early detection Infectious diseases emergency care end of life care Last terminal dx in aged, cosmetic care People with unhealthy lifestyles pay more for care
Costs, profits and income are reasonable and not excessive Minimize costs not directly related to care What 1st Health maintenance and early detection Infectious diseases emergency care end of life care Last terminal dx in aged, cosmetic care Interstate/intnl system for rare /complex problems
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1. Commission appoints local, then regional
   stakeholder peer groups with two trained neutral
   facilitators for each group to insure balance,
   clarity and consistency with values, principles
   and priorities outlined by citizens. These
   groups identify components of new health care
   system
2. Commission, in consultation with stakeholder
   groups, appoints representatives to make up three
   to five system design teams who each develop a
   draft design of a possible health care system

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Examples of Stakeholder Groups
Primary Care providers, nurses, patients Large, medium and small employers Rehabilitation providers People with disabilities
Specialty Care providers, nurses, patients Self-employed Hospice Local, State and Federal government representatives
Hospital providers, nurses, patients Labor unions Critical care providers Public Health representatives
Emergency and Urgent Care providers, nurses Uninsured people Rural and urban providers and patients Pharmaceutical companies
Medical records, billing staff Dental providers Medical researchers Pharmacists
Insurance and managed care providers Mental health providers Low income people Senior Citizens
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• Teams evaluate each others proposals and reform
  into two or three teams to design alternative
  systems.
• Third set of national town hall and stakeholder
  peer meetings to review, rate and provide
  feedback on two or three alternative proposals

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1. Commission develops single proposal and
   reconvenes system design teams to develop a
   transition process along with an evaluation and
   accountability system for improving health care
   over time.
2. Fourth set of town hall and stakeholder meetings
   to review, rate and provide feedback on
   alternative proposals for transition process.
3. Commission writes legislation and presents it to
   Congress.