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Letters to the Editor  |   August 2009
Sounding It Out: \ri-'fȯrm\
Author Affiliations
  • Carl G. Bynum, DO, MPH
    HealthCare USA, St Louis, Mo; Fellow, American Osteopathic Association Certificate Program in Health Policy♦
    Medical Director
Article Information
Professional Issues
Letters to the Editor   |   August 2009
Sounding It Out: \ri-'fȯrm\
The Journal of the American Osteopathic Association, August 2009, Vol. 109, 398-399. doi:10.7556/jaoa.2009.109.8.398
The Journal of the American Osteopathic Association, August 2009, Vol. 109, 398-399. doi:10.7556/jaoa.2009.109.8.398
To the Editor:  
When I hear someone ask if we need healthcare reform, I think about spelling bees. In spelling bees, competitors receive a word to spell. Each competitor then has the opportunity to ask the official to repeat the word, define it, use it in a sentence, or all of the above. 
Surely the discussion of healthcare reform deserves the same dignity as words in a spelling contest in terms of considering the need for and definition of healthcare reform and in placing healthcare reform in the proper context. So let us examine these three steps in the discussion process. 
I believe we can comfortably skip the first step—repeating the question—because the US public, healthcare professionals, and policymakers have repeatedly considered the question of whether there is a need for healthcare reform. I have not spoken with a single person who does not accept the urgent need for some type of reform in US healthcare. However, individuals disagree regarding which particular areas of the system need reform. Nevertheless, these areas can be consolidated into three main issues common to all health policy concerns: quality, access, and cost. 
At this point, I would impose another rule of order: anyone entering the “hall of reform” should be required to leave his or her personal agenda at the door. And trust me, everyone has an agenda. Of course, I'm not requiring a total abandonment of agendas—only that agendas have some level of transparency to allow for proper viewing of healthcare reform proposals. 
An examination of the second step of the discussion process—defining healthcare reform—provides deeper insight into the intent and direction of proposed change. Furthermore, it is imperative to understand the intended outcome of any proposed change. In itself, “change” has no intrinsic value. Rather, it is only a directional indicator, telling us if we are moving toward or away from a predefined goal. As previously indicated, the definition of healthcare reform must comprehensively encompass the issues of quality, access, and cost. 
Two caveats for the reader regarding this definition must be mentioned. First, do not let the definer lull you with merely rhetorical solutions. Discussions of healthcare reform must be factual, with well-defined goals and measurable outcomes. Second, do not accept simplistic solutions. Healthcare reform is not an easy task because healthcare is complicated—both as a science and as a business. 
Regarding the final, contextual step of the discussion process, “using the word in a sentence” complements our understanding of the definition of healthcare reform. Once again, healthcare reform must be defined and explained in the context of quality, access, and cost. Because of the complexities of healthcare, this part of the discussion challenges the ability of the listener to remain alert and to distinguish those issues that are salient for effective healthcare reform. Restraint must dominate the desire to move too quickly with reform—even though such restraint may be difficult because of the sense of urgency for needed reform. We cannot abandon due diligence for the sake of expediency. 
The specifics of any plan for healthcare reform must include a thorough understanding not only of the perceived benefits but also of the potential unintended consequences of the plan. In any revolutionary institutional reform, disaster can come from a disregard of unintended consequences, as illustrated by a warning from 17th-century British statesman George Savile, who said, “When the people contend for liberty, they seldom get anything by their victory but new masters.” 
In conclusion, no one doubts the need for healthcare reform, and we all hope that effective change can occur. However, this change cannot be based on hope alone. Successful reform will come from a compilation of the expertise of an integrated and inclusive group of stakeholders with a governing focus on quality, access, and cost.