Change Lessons from Obama’s Mistakes in Health Care Reform

I think there are few people who would disagree with President Obama’s view that America needs its healthcare system reforming, especially all those Americans who can’t afford health! The US system costs roughly twice that of those in Europe or Canada and is far less efficient. A medical degree seems to be a license to print money rather than to heal; Pharma and Healthcare industries seem far more concerned with profits than health.

Apparently 50 million Americans do not have health cover, so it is clearly and issue. Michael Moore made a film “Sicko” all about the inequities of this system. So all-in-all this appears to be a worthy cause for a new president to pick for reform, however nearly 9 months into his presidency, why does he appear to be getting nowhere with it?

Obviously this is a very complex issue and system and it is always hard to tackle something so big. There are a lot of strong feelings about this issue, both pro and anti, but these are complicated by the equally strong fears about high taxation and interference from government.

So where has it gone wrong? In I-Change we use a simple 5 step model to analyse change:-

  1. Need: There must be an unmet need, which is perceived as compelling
  2. Belief: You must be able to believe that Change is possible.
  3. Willingness: You must be prepared to do what it takes or make the change.
  4. Readiness: You have to have the necessary resources [time, knowledge, capability, budget, skill, experience etc.] to make the change happen.
  5. Action: You then have to do what it takes to make the change real, and having done so, ensure that it is maintained and that people don’t backslide.

So, how does President Obama fare against this map?

  1. Need: There is clearly a pressing need when 50 million Americans have no cover. However has the need been correctly identified? Do they need to just offer healthcare to these people or reform a system that is already costing 16% of the US GDP at $2.1 trillion?
  2. Belief: Apparently 54% of Americans don’t believe this bill will be passed this year. Failure to create a plausible target de-energises the reformers and gives heart to opponents 
  3. Willingness: Here is, I believe, the biggest obstacle. $2+ trillion represents a huge investment in the status quo; doctors, pharmaceutical companies, insurers and private healthcare facilities are all very rich, powerful opponents of any change. Without neutralising this opposition, or creating an equal and opposite body of opinion he cannot move forward. Presumably there are those who might be prepared to see the system reformed but do not want him to gain the political kudos for doing it. He has to somehow find a win:win solution when faced with this level of opposition. Here is where he has stalled.
  4. Readiness: I don’t believe he has marshalled the resources he needs to push this through and I have read that the bill will add $239 billion to the deficit, which would make it unfundable.

Every business I work in has its challenges with communication and usually this is a key element in what has gone wrong and also in moving forward. I don’t know how one of the great communicators has somehow failed to get this right, but perhaps any bill which is not only 1017 pages long and written in incomprehensible terms is doomed to fail.

It seems to me that there needs to be a root and branch reform of not only the system for paying for health but also on the principles and values that underpin it. What is more important the wealth of a few or the health of the many? Does America want to be a civilised country that shines as an example to others in the way it cares for its citizens or just be the country with the biggest, shiniest toys?

If you can’t show the people there is a simple, believable way forward, then they are unlikely to follow you, even if you are the most powerful man in the world! So remember that for your change programme to work you need to follow this simple roadmap to success.

“Give me your tired, your poor, Your huddled masses yearning to breathe free, The wretched refuse of your teeming shore. Send these, the homeless, tempest-tost to me, I lift my lamp beside the golden door!” Inscribed on the Statue of Liberty

“Nobody can go back and start a new beginning, but anyone can start today and make a new ending.” Maria Robinson

                                                                                                                                          © I-Change Oct 2009



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