Another thought from the World Health Care Congress, a gathering of about 1200 executives from all sectors of the healthcare industry.

Phil Bredesen, the former governor of Tennessee and previously a successful business leader, spoke and must have created some DNA-level spasm in Washington. Not because he was a Democrat willing to go on record as opposing the healthcare reform legislation, but because he did so forcefully, but with complete respect and civility. We sent him across the Potomac to give some lessons on manners.

Bredesen’s summary point is worth consideration. There are many ideas being discussed as key to solving our healthcare problem. A few include: Improving clinical quality, implementing information technology, developing more primary care physicians, reducing frivolous medical malpractice risks, buying insurance across state lines, and creating healthcare buying exchanges.

All good ideas, but not the real issue.

Bredesen’s point is that we have removed the fundamental economic tension between buyers (patients) and sellers (those of us who make money somehow in this industry).This is the core operating principle of any transaction. In removing this natural tension, we have created an untenable situation where no one has a real incentive to change.

Until we fix this, nothing else matters. Until we put all of the other cool ideas to the side and agree that fixing the economic tension problem is the main thing, we’ll gladly distract ourselves and never get to the real issue.