Independent Voters Will Make The Difference in Health Care Reform- And Everything Else

Independent voters (those independent of political affiliation of the two major parties) have always been a part of our political landscape. Both political parties target the “independents” during election cycles as the only way to assure victory because neither one can seem to acquire the numbers they need on their own.

From all of the talk in Washington, you would think health care reform is all about Republicans or Democrats- it’s not. It’s what the independents want that will make the real difference. For the first time in a long time, independent voters outnumber those affiliated with either major political party.

The Pew Research Center provides an interesting visual of the history of individual affiliation with our political parties over the past 70 years. You can link to it by clicking here.

Starting back with Franklin Roosevelt in 1939, independent voters made up 18% of the electorate. At that time, Democrats made up 41% while Republicans were at 35%.

As we all know, party affiliations change with the times. Democratic affiliation peaked at 51% in 1964 after the Kennedy assassination and Republicans dropped pretty substantially to 25%. Independent voters increased to 23%.

Since that time, the affiliations of both major political parties have continued to erode. With the exception of a brief spurt during the Reagan years, the Republican Party has had a tough time solidifying a base. Democrats have not had much more success.

Beginning in 1991, under Bush I, the Republicans, Democrats, and independents have all been competing as equals in addressing the needs of the American people. And, in 2009, independent voters now make up 36% of the electorate, Democrats have 35%, and Republicans 23%.

So as we continue on with all of the partisan politics that’s taking place in Washington regarding reforming our health care system, both parties better realize it’s not those that are affiliated with them that will be their staunchest advocates or most vocal critics. It will not be a Democratic or Republican agenda that will make a difference. It’s the independent voter that will have the biggest impact. Congress (both sides) had better listen.

And, from what we’re seeing, we can expect the independent ranks to grow even larger in the future. Because we don't think that they really are.

Consumers Value Health Care Different Than Health Care Values Health Care

I had the opportunity to speak at Life University’s homecoming over the weekend. Many thanks go out to the folks at Life, and particularly Dr. Stephen Bolles for making it a really enjoyable experience.

My topic was centered on “delivering value” in health care, not from a clinical standpoint or a health plan standpoint, but from a consumer perspective. We haven’t heard much about the consumer’s perspective of what they are searching for in the health care debate (except through the emotional interaction of the Town Hall meetings over the past few months). I'ts about time we started to listen.

I felt it was important for the audience at Life University (clinicians) understood the brutal realities of the health care market they are part of. We all know the numbers, we spend too much, our results aren’t what they need to be, and there is a very real possibility that the whole financial model could crash if we don’t do something about it. Consumers don’t trust the health plans, they don’t trust their employers, and they certainly don’t trust those in Washington making the decisions to “reform” the system we have today (I’ve written enough on my views on what’s going on with the whole reform fiasco). Due to the lack of trust, consumers get a lot of their information today via the internet. Eighty-eight percent of them validate the information they receive on the internet with their health care providers. Eighty-eight percent of those people then validate the validation they received from their health care provider with family and friends. Health care information is a social phenomenon.

The definition of “value” in health care from a consumer perspective (from the outside) has a very unique context around it. Value from a consumer’s perspective is something they can trust, is personally relevant to them, delivers the results they expect, and can help them navigate through the mess we have today when they need to navigate through the mess. Value is very personal when looking at it from the consumer’s eyes.

The definition of value for those inside health care is totally different. Value is based on outcomes and cost. Value is about following the right protocol or the right formula in delivering care. The value of health care is transactional- not personal. And, as we all know, our health care system has become a system based on a series of transactions- not relationships.

My argument has been that until we start to recognize and appreciate the definition of value from a consumer perspective, we’re never going to get them involved. They will continue to be merely participants aimlessly following the confusing rules and processes we have laid out for them. Yes, they might be “nudged” along by incentives (another transaction) to get them to do the right thing- but they are not going to engage and do the things we will need them to do to be truly engaged and active participants in their health and in the health care system itself until a relationship is established. We have a long ways to go.

Our health care system has become a fragmented array of individual self-interests focused very narrowly on individual points of view. To really reform our system will require a change in perspective for many of the individual self-interests to work in a more focused and integrated manner than they ever have before. And, while not discarding the health care system’s definition of value, they will need to focus much more on the definition of value from the perspective of those receiving care. Patients are not a transaction- they are a person.

Did anyone really hear my message at Life? I don’t know, but it felt good getting it out there for others to think about.

State Health System Performance- Confirming What We Already Know

The Commonwealth Fund just released its state scorecard on health system performance. We posted it on our site under the “Health Systems” section in our library at http://www.collaborationhealthcare.com/ or you can grab it by clicking here.

The study looked at a number of indicators to determine its rankings of the states. In 2009, Vermont, Hawaii, Iowa, Minnesota, and Maine/New Hampshire came out on the top and Florida, Louisiana, Nevada, Texas, Arkansas, Oklahoma, and Mississippi came out on the bottom.

The main message once again pointed to the significant variation between the states that continues to exist in access to care, quality, costs, and outcomes for individuals. Even those states at the top of the list had some room for improvement.

Perhaps most striking is the amount of dollars that could be saved in the system we have today simply by organizing care more effectively and dealing the costs associated with the unhealthy lifestyles of our population:

$5 billion for unnecessary re-admission to hospitals or nursing homes

$37 billion “outlier” Medicare costs

$193 billion for tobacco-related health care costs

$147 billion for obesity

So as we continue to move through the health care reform debate, we’ll continue to argue that the issue is not whether we have a public option, or co-ops, or whatever else we want to throw in there. The issue is not making the health plans, the doctors, or the hospitals the “bad guys”. The issue is how this system is organized and how care is delivered and paid-for in the system we have today. Until we deal with the fundamentals, the rest is simply irrelevant.

The Commonwealth Study only reinforced what we already know. I just hope we do something about it.