Health Care Reform Priorities

Philip K. Howard (left), founder of the Common Good legal reform coalition and a board member of Public Agenda, seen here at the December 2009 Maxwell School/Public Agenda Policy Breakfast, fielding questions from the audience and event moderator Robert Siegel of National Public Radio.

As the dogfight over health care reform moves toward an uncertain result, we were privileged to have the opportunity to hash out some of the issues at the most recent Maxwell School/Public Agenda Policy Breakfast, where our speaker was Philip K. Howard, a leader of the legal reform movement who has a unique perspective to offer on the problem.

Howard is an attorney who is a founder of the Common Good legal reform coalition, author of "Life Without Lawyers: Liberating Americans from Too Much Law," a member of the Public Agenda board, and a major advocate of malpractice reform. Common Good and the Harvard School of Public Health, with funding from the Robert Wood Johnson Foundation, is involved in a pilot project to test health courts – similar to the workmen's compensation system – using arbitration to resolve malpractice claims.

So Howard, while optimistic that the system being tested in the pilot project would do a better job of holding doctors accountable and delivering compensation to more patients, does not think this change alone would solve the health care reform problem. "It's important to have a system that provides health care for everyone - but it's still not a free good," says Howard. "How do we balance our need to provide health care with all our other important goals?"

He believes the health care system has become a mass of new laws and rules layered on top of old laws and rules - none ever really going away - so complex a result that no one knows it all and most can only just keep doing whatever was done the day before.

Asked by National Public Radio's Robert Siegel, moderator of the event, what he'd do if he were a tie-breaking Senator when the (still-evolving) legislation comes up for a vote, Howard said that's a tough call. But, he said, he'd probably vote for it, and use it as a pulpit to say that the agenda going forward must be cost control as number one, with universal care also being very important. He says he'd then build a coalition to support and work for those priorities.

Is this health care legislation then, more of a starting point than an outcome?

"Passing it, in fact, will provide some moral persuasion and an opportunity" to move forward, suggests George E. Thibault, M.D., one of the guests discussing the issue during the Policy Breakfast question and answer session. "It's going to set us [the country] back if we don't get it passed," said Thibault, president of the Josiah Macy, Jr. Foundation, which works for improved education and collaboration among health care professionals, as well as educational strategies to expand access to health care. "We're more likely to do the hard work if we do."