reform |riˈfôrm|  verb [ trans. ] Make changes in (something, typically a social, political, or economic institution or practice) in order to improve it.  (From OS X application Dictionary, v2.0.2)

There is obviously a lot at stake in the government’s current efforts to reform healthcare.  Healthcaare contains the constant moral dilemma of balancing resources with life, and also represents a huge percentage of economic activity that has its associated special interests.  Given that half of the spending in healthcare is currently controlled by the government guarentees that the decisions made will be the least common demoninator resulting from political compromise – or worse – a step backwards based on politiical self-interest.

Like many, I watched the beginning of this discussion with great optimism that some real reform would take place.  I have even spent a measurable percentage of my time (and more specifically my company’s time) participating in various programs for public input and advocacy, so a lot of the details are well understood.  But, I am becoming increasingly disappointed in the direction of the evolving legislation.  While the goals of expanding coverage are admirable and ultimately necessary, the path to get there is now looking more like 1960’s thinking and not 21st century thinking.  Back office agreements with the current system beneficiaries, fiscal manipulation, increased taxes, and retention of the current structure of employers, insurance, and claims.  All done under a forced deadline which will make sure that whatever we get is anything available before the deadline and not what is the right thing to do.  Add in a big effort to push the purchase of computer systems built on last centuries approach to healthcare (and largely rejected by physicians as useful for their work) to make sure we don’t move the infrastructure forward.

Let’s stop calling this reform and start calling this healthcare expansion under the current structure – a structure we know doesn’t work.  Anything that preserves the fee-for-service backbone is a vote for non-reform.  Solving the model of healthcare payment should be figured out before we even get into the debate of where to sit on the spectrum of nationalizing healthcare.

How about this: run any number of pilot projects that use a medical home model, primary care focus, community clinic focus, or anything that provides a market incentive for wellness.  And include incentives for the average patient to take responsibility for their own health.  And separate us from our employers so we have some idea what healthcare actually costs.  Publish the results of the pilots to figure out the best practices.  Here’s a great source for the pilot programs: use any of the existing federal programs.

Then we can start using the word “reform”.

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