Analysis: Obama Reforms Require Sacrifice

Les Masterson and John Commins , March 9, 2009

Sacrifice is emerging as a recurring theme in President Obama's call for healthcare reform. At a half-day healthcare summit at the White House on Thursday, the president told a room full of key stakeholders on the issue that there should be no "sacred cows" in the discussion on healthcare reform, which he said will require sacrifices from everyone.

"Each of us must accept that none of us will get everything we want, and no proposal for reform will be perfect. If that is the measure we will never get anything done," Obama told about 150 people from the across the healthcare spectrum who were invited to the meeting. "But when it comes to addressing our healthcare challenge, we can no longer let the perfect be the enemy of the essential."

Bill Roper, MD, the CEO of UNC Health Care and the former director of CMS and CDC, says the public will most assuredly have to make adjustments in their own healthcare services to make the reforms work.

"Sacrifice is inherent in remaking the system," Roper says. "It's right to start talking about sacrifice because that is what is going to have to happen if we are going to have better quality and more cost-effective care. We've got to implement better information and better protocols and guidelines for the management of patients."

"We spend more per capita than any other nation in the world, so I would stipulate that we have plenty of money in the system. So, to cover those other approaching 50 million uninsured people means taking something that is currently being spent on you and me and spending it on a person without health insurance. That by any other name is a sacrifice."

Americans weren't willing to make that sacrifice in 1993, when President Bill Clinton tried unsuccessfully to push through sweeping healthcare reforms. "The Clinton reform effort ran aground when the average American realized that what was really being discussed was restricting their ability to do something and thereby save money from their care and use that freed up money to fund the care of somebody else," Roper says.

Roper says he has long been "deeply committed" to evidence-based medicine and he supports the $1.5 billion in Obama's stimulus plan that is earmarked for the process. "But what that means is we will come up with better information on what works in what setting and that means we will say 'no' to your request for knee surgery or x, y, or z procedure," Roper says. "That means a sacrifice. The American people are owed our honesty in this debate and I'm delighted that we are beginning to do that. To go around saying, 'We have the world's best healthcare system,' which we don't, and saying, 'You can keep every bit of healthcare you got if you want to keep it,' are just not going do it."

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