January 25, 2010

Health care reform is a secret process; it’s time to rethink who’s in charge

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Op-ed by Mark Trahant

Perhaps one reason why the massive health care reform legislation is in so much trouble is that few people understand the details. The bill is massive, complicated, packed with official government jargon and so many specifics were kicked forward to regulators at some future point (such as figuring out the real Medicare cost reductions or definitions of basic terms such as “quality”). On top of that, there was confusion about the nuts and bolts of what program was in, and what was out. Essentially it was a secret process, except when there were leaks over specific proposals.

The bill followed the time-honored way of legislating. A senator says, “yes” after the bill is sweetened. Then another senator is wooed. And another until a super majority is found and the bill itself is hardly identifiable. Political horse-trading is one of the reasons people are angry about health care reform (as well – and this is important – a genuine debate about the role of government). It looks unfair and unseemly.

But does it have to be that way in the 21st century? Can legislation or policy be forged in an open and transparent manner? This won’t resolve the debate about philosophy, but at least it allows people to have a say all through the process.

I think this is the way forward – and I’d like to see Congress, the Executive Branch and the Indian Health Service all have clear social media strategies that harness the power of an individual to help shape a larger mission.

This is not a new concept. The United Kingdom’s National Health Service is trying to harness social movement ideals. “In addition to changing structures and processes within health care, we need to embrace new sorts of fresh thinking and fresh perspectives to get better, faster, more sustainable results,” wrote Helen Bevan, chief of service transformation at the National Health Service’s Institute for Innovation and Improvement in the report, The Power of One, The Power of Many.

What sort of fresh thinking?

Start by rethinking just who’s in charge. “Action and decision-making were really devolved rather than centralized,” the NHS said. “Where people could take action without reference back up the chain. Power was exercised by an empowered staff rather than just those with formal authority.”

This kind of empowerment only works when it’s voluntary. Social media connects because people swarm around interesting people. It’s the same in a hospital staff when, the NHS found, “people did what they wanted to do, not what someone else wanted them to do.”

“At this point the reader may well be asking, ‘why should I believe any of this? And anyway, are social movements not completely different from organizations?’ Both are reasonable questions,” the NHS said. And the answers must be “evidence based.” The British health system says the pilots are still in early stages, but there are already many lessons surfacing.

Another example of fresh thinking is engaging – and seeking out feedback even when it’s critical. (Often there’s more to learn from a negative review, than a positive report.)

The independent site Patient Opinion asks patients to post: “If you’ve experienced health care recently, either as a patient yourself or as a carer or friend of someone else, please tell us how it was. What was good? What could have been better?”

The conservative opposition party in the United Kingdom is demanding more transparency and use of Social Media for the National Health Service. One proposal is a prize of 1 million pounds for a website to “harness the wisdom of the crowds” for reviewing transformative proposals. One Tory Party leader, John Dehmam, told The Financial Times to overhaul online “local spending reports” giving the public real time information.

Critics dismiss this as an election gimmick. That could be. But it’s clear that transparency is a new currency in public discourse. Much of the anger about the health care reform bills could have been channeled into discourse had there been real time, useful information online. Why not a wisdom of the crowds approach to solving the two pressing problems in health care, namely expanding coverage to all Americans and reigning in the costs.

A few years ago three hundred million ideas would be unmanageable. Not so now. I can think of lots of ways that Congress could have made this reform process open and transparent. What about a chart in real time with all of the proposals, leading to a column that tells what’s in and what’s out? When it changes, just say so. No big deal. Or even more bold, could Congress handle a Wiki that collects ideas from every American? It’s worth an experiment or two.

Mark Trahant is an advisory board member of InvestigateWest and a Kaiser Media Fellow examining the Indian Health Service and its relevance to the national health care reform debate. He is a member of Idaho’s Shoshone-Bannock Tribes. (Next: Transparency and the Indian Health Service)

One thought on “Health care reform is a secret process; it’s time to rethink who’s in charge

  1. Using the power of social networks to explain the health care reform plan would be great. It’s not too late: a real time chart that shows what is in the Senate version, and what House members feel is missing would illuminate the process even know. Going further to gather the wisdom of people –especially people without access to care– would be an even better step.