In a restaurant, it’s called being in the weeds: when the duties of one’s job become so overwhelming that you can’t keep up with the pace. Think five new admissions at the end of a 12-hour workday.
That’s where Norm Ornstein, one of the keynote speakers at HM12 in San Diego, can help. A resident scholar at the American Enterprise Institute in Washington, D.C., and a longtime observer of all things political, Ornstein is in the weeds of healthcare reform on a partisan and policy level. He pens a weekly column for the Congressional newspaper Roll Call and also provides election analysis for “CBS News.” He has authored or edited multiple books, including “Intensive Care: How Congress Shapes Health Policy” and “The Permanent Campaign and Its Future.”
So hospitalists who too often feel that, between patient care and clinical research, they don’t have time to study the political landscape should probably plan to attend Ornstein’s address, tentatively dubbed “Making Health Policy in an Age of Dysfunctional Politics.” The Hospitalist spent a few moments with Ornstein as he prepared for his HM12 address.
What do you plan to speak about and what do you want hospitalists to take away from your talk?
We’re really going to be looking toward the fall matchup in the presidential campaign. And we know that health policy is going to be not the No. 1 issue—it’s pretty clear now that the economy and jobs will be the No. 1 issue—but it will be following pretty closely behind at No. 2. And we know we’re going to get a very hot debate on whether we can or should repeal the Affordable Care Act (ACA). … But we also know that, repeal or not … health policy is up in the air. We’re going to go through some tumultuous changes. Everybody is on the line; who’s actually delivering services, or trying to, is going to have enormous challenges. It’s a perfect time to talk about these issues.
Healthcare professionals aren’t used to being part of the political maelstrom. What is their role in this process?
If anything, the last year or two should make it very clear to them they better be involved. … Whatever happens with the Affordable Care Act, we’re going to be making adjustments in public policy, and we’re going to be seeing massive adjustments in the private sector for years to come. Lots of people are going to be looking for the best ideas and looking for ways to make sure we can bend the cost curve, to use the cliché, but not sacrifice significantly services to people—and maybe even improve those services. It’s time, I think, for people in this world to understand it’s in their own self-interest to be engaged.
How nervous should hospitalists be that there really is a chance the ACA can be repealed?
I don’t think they should be worried that the whole kit and caboodle will be replaced. I think they should be concerned that we will see a combination of some elements of it perhaps repealed, but even more that the corrosive nature of our politics is such that Republicans, if they can’t repeal it, will do everything they can to bollocks up its implementation so that they can both score political points but also say, “See, we told you so.” This would be a challenge under the best of circumstances to make this work. But I think everybody has to be braced for what I think will be a series of some substantial bumps and jolts in the road along the way.
That is a lot of uncertainty for a hospitalist. How can they prepare?
I don’t think one can prepare adequately for the changes that are going to take place. What hospitalists have to do first is to make sure that they fulfill their own roles in caring for patients, but they should also be thinking about innovative approaches and ways of delivering services that are good for patents but also good for the system.
Is that enough—being at the vanguard of care delivery?
No, and I can’t give people assurances that there is any specific thing they can do that will make things work, or work better, because we’re moving into an uncertain environment—an uncertain environment in the real world where we’re going to see health as a share of GDP probably continue to go up for a while, but there will be some pushback against that; uncertainty as we try to integrate the public and private halves of our healthcare system a little bit better than we have; uncertainty as we find that the fiscal realities of America mean that you’ve got to put even more of a squeeze on Medicare, Medicaid, and even veterans’ health. Those things don’t happen in isolation.
Should doctors see this as an exciting time?
I think there is a bright side to this, which is there really is an opportunity here for innovation in ways to fulfill their oaths. There is an opportunity to find ways to provide better healthcare for people, better services to make their lives better.
Richard Quinn is a freelance writer in New Jersey.
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