Changing Our Perspectives on Healthcare Reform

This has been a hard—occasionally embarrassing and even frightening—time to be an American. The healthcare reform and reconciliation bills have ushered in some of the nastiest political bickering and fear mongering seen in my short lifetime. Our media megaphone that so thrives on conflict, over-simplification, and 24 X 7 soundbites has left us shouting and cursing at one another—and sometimes worse—at levels that far exceed what seems reasonable, healthy, and warranted, especially given the actual content of these pieces of legislation. To be perfectly honest, I have been reluctant and a little afraid of writing and publishing this blog entry out of fear of the conflicts it may generate for me and my inbox.

But we can’t live our lives in fearful silence. And we need to do some perspective-taking here.

We in this country need to take more of a global view. My friends and colleagues from other countries are baffled by our nation’s extreme behavior. One friend wrote: “How is it that going to war in Iraq generated less ire and angst than these healthcare reforms?” This is a valid question that is hard to answer, but his assessment feels pretty close to the bone. Another colleague, one who lives in Africa, put things into even greater perspective for me: “America still doesn’t ‘get it’ that you live in a world of extreme privilege and luxury if the most anger you can muster is over a healthcare bill while many of the rest of us in the world deal with things like pervasive poverty, terrorist attacks, and dictatorships on a regular basis.” All our rhetoric about Armageddon, doomsday, and government takeovers feels overbuilt and overblown when we step back to realize that many other parts of the world live that chaos as a daily reality—that “government takeover” has a qualitatively different meaning in a place like Uganda. Methinks we doth protest way too much!

We also need to take the long view of things. This healthcare reform effort is older than most of us—older than most of our grandparents—with roots going back to Theodore Roosevelt’s 1912 campaign, if not before. This is not the first bill, nor the last, to deal with healthcare reform. But it is the first major bill in a very long time on the topic, after Presidents of all political stripes have failed to get something passed for almost 100 years. That is the sense in which this bill passing is “historic,” not because it magically solves all of our problems (as some proponents overly celebrate!) but because it begins to break the century-long log jam of political taboo around healthcare reform that has plagued White Houses and Congresses for far too many generations.

This bill puts a stake in the sand, which this and many future Congresses will enhance, fix, tweak, and revise as we make mistakes, discover things, and change political parties many times over. That’s the way things work in a messy checks-and-balances system that works itself towards balance, even success, over long periods of time. The notion that we’re now done with healthcare reform because this bill passed is ridiculous. It’s an ongoing process, an endless debate if we’re honest with ourselves, that our political system is set up quite intentionally to deal with in slow, iterative, and sometimes conflict-filled but non-violent ways.

We also need to take a more holistic view of this legislation. I don’t love the health reform bill—in fact, there are parts that I detest. But I am nonetheless happy and relieved that it passed as a whole. Could the bill have been much better? Absolutely. Especially if opponents had decided to stop their obstruction strategy early on in favor of negotiating, compromising, and crafting something better for the country. And especially if proponents had done a better job of managing the process and public expectations by communicating better—and more accurately—about the main features of the bill. Is the bill perfect? No, not by any measure. But no bill ever is. Waiting for the perfect bill would be waiting for a day that never comes.

As a whole, the bill will begin to address some of the fundamental reform challenges that our nation faces. With more than two thousand pages in it, anyone can find specific line items, language, or whole sections that you hate. (We don’t get a line item veto as citizens, so sometimes you take the bad with the good and fight to fix the bad parts later.) But to my reading, there are four tenants that the legislation in its entirety starts to enact. First, moving us towards universal coverage, of both individuals and conditions. Second, prioritizing prevention over expensive crisis-driven care that we do today. Third, moving payment of care towards quality over quantity of care. And fourth, increasing but regulating market competition for insurance. Sure, there are other elements in the bill that I don’t like and many things not in the bill that should be (like prioritizing home-based care that I blog about incessantly here and driving more cost controls!). But it’s as good and comprehensive of a start I can imagine at this moment in our history.

Finally, as we think globally, longitudinally, and holistically about these reform measures, we also need to take a personal perspective on all of this. We need to stop and ask ourselves if our reactions—positive or negative—are justified, and do we know what we really think we know? How have we come to believe what we believe? Just this week, I’ve heard Medicare recipients screaming about the evils of this supposed government takeover of healthcare, but also demanding no cuts to their Medicare benefits. I’ve heard employees clamoring about their benefits being taken away when the legislation actually changes nothing about their current choices. I’ve witnessed some of the wealthiest members of our society lamenting the loss of a few thousand dollars as if it is the end of civilization as we know it. I’ve seen shouting matches between “liberals” and “conservatives” both claiming that the bill creates a public option, when that was removed from the bill some time ago.

In our perspective taking, we need to strive to learn what is really in the legislation and what is not, and to evaluate how those things will impact each and every one of us personally. We need to stop letting Parties and Pundits and Politicians use the media megaphone to tell us how to think and feel about these bills and do our own homework. This will take time as summaries of so many thousands of pages get written, as myths and misperceptions get corrected, as our nation finds balance again from the extremes that play upon and fuel our emotions. With 9/11 and other world conflicts, we’ve been through some terrible times as a nation. This is not one of them. The sky is not falling. And we cheapen those historical moments—and ourselves—if we let our reactions to this healthcare reform bill supersede the more serious problems we face.