The President's Town Hall Meeting

The President held a town hall meeting at the White House yesterday that was given more than an hour of time on network television. This reflects the importance of the topic at hand--health care reform. There were a number of interesting comments made, although one observer pointed out that there was really nothing new and earth shaking that was discussed.

What did catch my attention, even if it was not so new, was the statement that people who are satisfied with their current insurance and their current doctor (which, for my nursing friends, will hopefully translate into a more general term, "provider") should not have to make a change. However, the President also used the cliche about the devil you know being better than the one you don't--in other words even if we are not thrilled with our current health insurance or provider, we know the problems with what we have and we fear what we may get instead. If we combine these two ideas, despite new choices being offered to those who have no other option, those with a choice may make the choice to stay in their current insurance plan with their current providers. If so, nothing about those people's health care utilization is likely to change.

I should say--at first. We will probably need everyone's health care utilization to change in some way if we are going to control costs in the long run. One way to get around the possibility that little change will occur for people who don't change insurers or providers is to change incentives at other levels. For instance, incentives for employers, insurers, providers, and facilities could change. This would be sort of a "behind the scenes" approach to making change.

With that in mind, politicians and the public will have to figure out whether it is ultimately preferable for the public to face new incentives (whatever they may be) head on or to face similar incentives for themselves but find that they will be asking their providers why things are changing around them as providers' incentives change.

Click here for an audio version of the blog.