The Emergent Logic of Health Reform

Thursday, January 29, 2009 - 12:30pm to 2:00pm

Theater, Coffman Memorial Union

His core proposition was that the law of health care provision is best understood as an emergent system. Its contradictions and dysfunctions are not the fault of some failed master designer. No one actor has a grand overview — or the power to impose a unifying vision. Countless market players, public planners, and legal and regulatory decision-makers interact in oft-chaotic ways—clashing with, reinforcing, and adjusting to each other. Out of these interactions, a larger scheme emerges: one that incorporates the health sphere's competing interests and values. Change in this system, for worse and for better, arises from the interplay between its myriad actors.The American health care system is on a glide path toward ruin. Health spending has become the fiscal equivalent of global warming, and the number of uninsured Americans is approaching 50 million. Can law help to divert our country from this path? There are reasons for deep skepticism. Law governs the provision and financing of medical care in fragmented and incoherent fashion. Commentators from diverse perspectives bemoan this chaos, casting it as an obstacle to change. In his talk, Prof. Bloche contended that pessimism about health law's prospects is unjustified but that a new understanding of health law's disarray is urgently needed to guide the project of reform.

By quitting the quest for a single master design, Dr. Bloche believes we can better focus our efforts on emergent possibilities for legal and policy change. We can and should continuously survey the landscape of stakeholders and expectations with an eye toward potential launching points for evolutionary processes — processes that leverage current institutions and incentives. What we cannot do is to plan or predict these evolutionary pathways in precise detail; the complexity of interactions among market and government actors precludes fine-grained foresight of this sort. But we can determine the general direction of needed change, identify seemingly intractable obstacles, and envision ways to diminish or finesse them over time. Dysfunctional legal doctrines, interest group expectations, consumers' anxieties, and embedded institutional and cultural barriers can all be dealt with in this way, in iterative fashion. Dr. Bloche set out a strategy for doing so. To illustrate this strategy, he suggested emergent approaches to the most urgent challenges in health care policy and law — the crises of access, value, and cost.

Read the related article from the Minnesota Journal of Law, Science & Technology.

The Deinard Memorial Lecture on Law & Medicine is co-sponsored by the University of Minnesota's Joint Degree Program in Law, Health & the Life Sciences and the Center for Bioethics.

Support for the series comes from the law firm of Leonard Street and Deinard and the Deinard family.

Larry Jacobs, PhD
Director, Center for the Study of Politics and Governance
Walter F. and Joan Mondale Chair for Political Studies
Humphrey Institute, University of Minnesota

Steve Parente, PhD
Academic Director, Medical Industry Leadership Institute
Carlson School of Management, University of Minnesota

Continuing legal education credits (CLE) for attorneys (1.5 hours) are approved.

The University of Minnesota is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Application has been submitted for AMA PRA Category 1 Credit. It is the policy of the University of Minnesota Office of Continuing Medical Education to ensure balance, independence, objectivity and scientific rigor in all of its sponsored educational activities.

M. Gregg Bloche, MD, JD, is Professor of Law at Georgetown University, Adjunct Professor at Johns Hopkins University's Bloomberg School of Public Health, and Visiting Fellow at The Brookings Institution and the Harvard Program on Ethics and Health. Prof. Bloche teaches and writes on US and international health law and policy. His recent work has appeared in numerous academic and professional publications, including the California and Stanford Law Reviews, New England Journal of Medicine, Journal of the American Medical Association, and Health Affairs. 

Prof. Bloche received a Robert Wood Johnson Foundation Investigator Award in Health Policy Research for 1997-2001 for his work on the legal and regulatory governance of managed care, and he is a member of the editorial boards of several journals, including Health Affairs and the Journal of Health Economics, Policy, & Law. He has served on the Institute of Medicine's Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care, the Committee on Scientific Freedom and Responsibility of the American Association for the Advancement of Science, and the board of directors of Physicians for Human Rights. He has been a consultant to South Africa's Truth and Reconciliation Commission (on human rights in the health sector), the Federal Judicial Center, the National Institutes of Health, the World Health Organization, several House and Senate committees, and other private and public bodies.

Prof. Bloche received his MD and JD from Yale University and his BA from Columbia University. Before joining Georgetown's faculty in 1989, he completed his residency in psychiatry at the Columbia Presbyterian Medical Center. He received several awards for research and scholarship as a resident physician and law student, and he was an editor of the Yale Law Journal.