When the policy wonks of the pay-for-performance world gathered in Los Angeles last week, the focus rarely ventured too far from detailed discourses on such topics as incentive formulas, measurement-domain weighting, rates of return and risk-adjustment strategies.
But there was one brief but electric interval, midway through the three-day gathering, when the conference enjoyed an unscheduled boost of Hollywood star power. That, of course, was when Arnold Schwarzeneggerthe former Mr. Universe and top-grossing actor who is now the chief executive of the nations most populous stateslowly limped to the dais at the Beverly Hilton, still walking with the assistance of a single crutch nearly two months after breaking his leg in a skiing accident in Sun Valley, Idaho.
The governator, dressed in a dark suit and tie, seemed to bask in the warm glow of a raucous reception from some 600 men and women gathered for the second annual national summit on pay-for-performance, which was sponsored by the Oakland, Calif.-based Integrated Healthcare Association. Speaking for only about 10 minutes, Schwarzenegger delivered a tailor-made speech with lots of applause lines as he laid out his decision about five weeks earlier to launch a bold plan to provide insurance to every resident of the state.
Befitting his own background and the site itself, he kicked of his remarks with a brief nod to Hollywood. Of course, Schwarzenegger had appeared on the same stage four weeks earlier, also aided by crutches, to present the best-movie award to Babel at the Golden Globes. A few years ago, of course, the star of such films as Kindergarten Cop, Twins and The Terminator, might have been far more concerned with those little statuettes than crafting an entirely new way to provide insurance to the masses. Talk about a big shift in priorities. Pumping up his healthcare plan, he said, This is much more important, I must remind you, than the Golden Globesor winning the Golden Globes.
Echoing the sentiments of many conference participants, Schwarzenegger said he is determined to transform the way healthcare is delivered in the Golden State, helping set the stage for reform across the country. Its a broken system, he said. This is the year we want to fix the broken system once and for all.
During the brief question-and-answer session, one awestruck interrogator pitched a big softball the governors way, asking why Schwarzenegger decided to launch such a bold and ambitious healthcare plan. The governor easily knocked that one out of the park.
Some people will approach things in incremental stages, he said. Thats not my style. If it was, I would have tried to win Mr. Austria, instead of Mr. Universe. And I didnt say I wanted to just go into movies; I said I wanted to be bigger than Clint Eastwood and Charles Bronson.
I always shoot for the top. Lets try to do something that hasnt been done in the U.S. Lets break new ground.
The governors plan, which would cost more than $12 billion a year and provide insurance to more than 6.5 million Californians who now lack coverage, was greeted with considerable skepticism by political observers who felt the sweeping initiative would never achieve the necessary consensus from disparate groups with competing interests. But he said hes already made significant strides.
Now, five weeks, later, weve had all of the groups come together and stood with me and said, Were here to be part of this coalition, Schwarzenegger said, smiling broadly. Theyre saying: Yes, this needs to be done this year. No one will get what they want. Thats always the case when you compromise. Whats important is that we do the best possible job for the people of California and the best reform that this country has ever seen.
In some ways, participants of the pay-for-performance summit are trying to do the same as the governorthat is, attempting to break important new ground and improve a healthcare system grappling with runaway costs and misaligned incentives. The sponsoring Integrated Healthcare Association operates the nations biggest pay-for-performance plan, providing tens of millions of dollars in incentives each year to some 40,000 doctors who care for more than 6 million patients. But most other plans have far less impact, and the model itself has struggled with issues ranging from physician resistance to measurement criteria.
And despite the enthusiasm for the governors brief appearance, there wasnt a lot of cheerleading from a fairly subdued crowd.
This skepticism was perfectly expressed by one attendee who waited impatiently late one afternoon for the promised shuttle bus to one of the conferences overflow hotels, this one located about two miles from the Beverly Hilton. The buses, scheduled to run every half-hour or so, were intermittent at best, forcing some irritated attendees to hail a cab.
The shuttle buses were a really good ideaand I told the conference organizers that, too, he said during the long wait in the warm Southern California sunshine. But it turns out there shuttle buses are a lot like pay-for-performancea good idea that hasnt really worked out so well.