Like everything else in Washington, health care reform discussions seem to have devolved into “left” vs. “right” and talking heads. Attributed to the left is the wish for a public plan. Attributed to the right is a refusal to accept that alternative. Like everything else in life, the debate is more complex once you get past the pundits and into the people who know.

Former secretary of Health and Human Services Michael Leavitt was iinterviewed in the Washington Post.

The man who helped oversee Medicare in the last administration describes the nation’s biggest government-run health plan as a fiscal disaster, and he says reform proposals that would build on it are a prescription for failure.

The federal program for the elderly and disabled provides uncoordinated care, it is indifferent to quality, and “every incentive in the system is to provide more care, not better care,” Michael O. Leavitt, who served as secretary of health and human services under President George W. Bush, said in an interview yesterday.

That could be dismissed as a critic from the right, if the head of Kaiser Permanente, whose clients are many of the large unions, hadn’t said largely the same thing, according to Merrill Goozner, long-time health reporter:

“We need to accelerate the pace of actual delivery reform in the package,” he told a press briefing following his presentation to the second annual meeting of the Kaiser Permanente Health Care Institute at the National Labor College in Silver Spring, Maryland. Setting goals like those in the House bill is “directionally correct,” but “we can get to those goals much faster,” he said.

About a third of Kaiser’s nine million enrollees are union members, and this year’s conference is dedicated to promoting greater use of integrated care models. Both Halvorson and John Sweeney, president of the AFL-CIO, who jointly addressed the opening session of the day long meeting, backed using Medicare to drive greater efficiencies through the entire system and setting up a government-run commission like the Medicare Payments Advisory Commission to reorganize payment policy.

“Congress should be considering an independent process,” Sweeney said.

Both the left and the right know that the delivery system is as much at fault as the insurance companies, and that neither public nor private reform will work if the compensation systems and incentives in health care don’t change, too. Integrated health care services (with excellent reputations) such as Cleveland Clinic and Mayo Clinic have been agitating for reforms that make the American health care system look more like what they provide, which offers high quality care at lower costs. From a recent New York Times article

The Cleveland Clinic is a not-for-profit medical research and treatment center that is considered one of the country’s best and most prestigious medical institutions.

President Obama, as part of his fight to change America’s health care system, visited the clinic on July 23, 2009. At a news conference the previous night, he called it a model of efficient care, saying its patient care system “works so well” because it has “set up a system where patient care is the number-one concern, not bureaucracy.”

Like the Mayo Clinic in Rochester, Minn., the Cleveland Clinic pays its doctors a salary, rather than piecemeal, and delivers excellent results for relatively little money.

In 2009, U.S. News and World Report rated the Cleveland Clinic as the fourth best hospital in the United States. The magazine has for the last 15 years said the clinic offers the best heart care in the country

In the light of all this, it would be helpful if we got beyond public plan vs. no public plan to what kind of plan we really want and can afford.