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Health Care Rationing is Inevitable - Unless We Build the Alternative

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As President Obama makes it increasingly clear we are going to reform health care this summer, the parties are drawing lines in the sand and everyone is choosing sides for the long-haul. For the Democrats, the public health insurance option is a key part of the agenda. Meanwhile, the Republicans remain strongly opposed to a public insurance program because it would indicate "a federal government takeover of the health system."

Bipartisanship on this issue, if it was ever alive, is dead as a doornail. That means the "moneyed interests," - the hospital, Information technology, insurance and pharmaceutical industries - are pouring millions into whatever side looks best for them. It's a lobbyist's dream.

It's not going to pretty. In fact, as the divide widens, it's getting uglier every second. Far-leaning political commentators are accelerating their bombast. Although they may not have the answers, they certainly have the TV and radio clout to pour oil on the fire and create lots of unnecessary "sound and fury."

When the story of the "Great Health Care Debate of 2009" is told in the future, will it be Shakespearian?

.... a walking shadow, a poor player
That struts and frets his hour upon the stage
And then is heard no more: it is a tale
Told by an idiot, full of sound and fury,
Signifying nothing.

Will there be strutting and fretting? Of course.

And will there be tales told by idiots? I fear so.

But what will it all signify? Is it possible that all the lines in the sand and all the bloody battles fought over them will ultimately amount to "nothing?"

Certainly not. For me, you, our loved ones, and our futures, this summer's debate will bring America's leaders to one terrifying, yet vastly important truth - no matter who pays, we can't afford our current care system.

The first shoe dropped this weekend as President Obama announced another $313 billion in cuts to health care programs for the elderly and the poor. He has no other options because we are out of money. He is taking hospitals and other providers at their word that they will reduce costs. That's a problem because the record shows they can't deliver.

I have been a physician for 40 years, as well as a health care executive, academic scholar, advisor and, most importantly a patient, immersed in our chaotic health care system. In my experience, there is almost nothing in current cost control proposals that has not been tried before and failed to control health care spending.

"Almost nothing" means something has worked. That "something" is care rationing. I will guarantee that no matter what health care reform legislation passes though Congress this year, your care and your family's care is going to be rationed in the future. It won't matter if you're a Democrat, Republican, rich, poor, executive, worker, advantaged or disadvantaged. There is no other option beyond care rationing because there is simply no money left.

I've worked in systems that ration care and I don't like it. But since rationing is inevitable, now is the time to start developing the alternative - a system that is not so costly, but always delivers exactly what the patient needs. Rather than working to reform the existing system with no money, no resources, and an overabundance of sound and fury about what should and shouldn't be done, America must refocus on building a new system that meets these fundamental goals of health care. Such a system will slowly, surely quiet all that sound and all that fury.

Building such a system is the subject of my forthcoming book, "Designed to Adapt: Leading Health Care in Challenging Times" (Second River Healthcare Press, 2009).

Based on my work as a Visiting Scholar at Harvard Business School studying those few organizations that excelled at managing complex, dynamic, unpredictable work, I've developed a process for redesigning health care organizations to always get patients exactly what they need at continually lower cost. I call it "Adaptive Design." It's a method that enables management, staff and physicians to problem solve the system when patients don't get what they need as part of everyone's everyday work.

Capturing the knowledge and creativity of everyone in the organization always pays dividends. For example, one operating room in an east coast hospital working adaptively increased the number of cases done by 16 percent at the same time that they decreased overtime by 14 percent and made their operating room much safer for patients. In other words, they lowered the cost of care and improved quality - simultaneously!

As more and more organizations begin to work adaptively, we will create health systems that are accountable to the patient and meet their needs at lower cost. What's more, we'll arrive at a clear alternative to care rationing, and we might be able to avoid the inevitable.

No sound, no fury. Just a better way to fix health care.