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Health Care Debate

Health Care Debate

With no apology offered, I will be venturing into a very subjective realm, namely, a characterization of today’s healthcare dialogue and what, in my opinion, might be an improvement.

I would suggest we have fallen into the trap that was partly enhanced by email and blogs, namely, that we can say outrageous things impolitely and without consequence.  With email we tend to be much blunter and impolite than we would be face to face.  On blogs, we can be positively toxic.  It’s like driving in a car with a tinted windshield that no one can see through.  You are anonymous and therefore can act less responsibly.

Another vignette.  I grew up in a very small upstate New York town where everyone knew everyone else.  You used your car horn to beep “hi” or to warn, and not in anger, ever.  When you waved at someone, it was with all five fingers.  And so on.  I think you get my point.

The healthcare debate always has stoked emotions like almost no other.  It is intensely personal, and the stakes are high.  We’re all involved and engaged.

As I’ve written in the past, I first earned my stripes as a lawyer representing my local Blue Cross plan in rate hearings.  These rate hearings always started with “public comment.”  The comment ranged from pure outrage to controlled anger to discontent coupled with suggestions.  What did we pay the most attention to?  Of course, the latter.

In healthcare, this really got rolling in 1993-94, when the Clinton Administration tried to reform healthcare.  Derek Bok has an informative description in Chapter 9 of of a larger work entitled “Public Discourse in America” (Rodin & Steinberg, 2003), where he states that “Interest groups spent large sums communicating with the public, but most of their efforts seemed designed less to inform than to arouse latent fears and anxieties and to reinforce existing views.” One of the points of the larger treatise was to point to sports, where outrageous, disrespectful behavior seemed to be accepted and rewarded.  Actually, as a survivor of the 60’s, I can recall how some of my contemporaries learned that outrageous protest got the most traction.  I think it’s called, “the squeaky wheel gets the grease.”

Before 2010, it was bad enough, but then came Obamacare.  The debate, usually divided by party lines, covered no one in glory.  Each side engaged in dreadful misrepresentations.  This escalated into what I call “cartoonization.”  My English teacher would hang me for that one (verbalizing a noun so to speak).  Our President recast the issue from health care reform to health insurance reform.  That unfortunate switch also switched the focus from the delivery of healthcare to its financing.  While financing is important of course, it’s the cost of what we’re financing that has gotten us to where we are today.

So, we had insurers portrayed as the systemic evil.  And from the other side of the aisle, such healthcare experts as Sarah Palin suggested that reasonable end of life initiatives such as living wills were “death panels.”

The idea, not dissimilar to the purpose of a good blog, is to advance intelligent debate on important issues.  That means an exchange of ideas.  Not just one voice howling at the moon.  Usually, with an exchange of ideas comes better perspective.  IF one is listening.  What seems to have happened is that a lot of people are writing vociferously, but not really considering the offered criticisms or alternative views.  THAT is unfortunate, because when that happens, no views are enhanced.

There is a fine article on line by Henry Doss titled “Healthcare Debate in US:  Can We Talk?”  He states:

“The national dialogue is about payment systems, and it should be about cost.  The national dialogue is about expense, when it should be about consumption.  And the national dialogue is about who merits what when it should be about dignity and human autonomy.”

He suggests that our national dialogue is grounded in the absence of trust, and that some degree of trust is needed to move us to the next level.  I applaud and agree with that.  Trust that the critic is coming from a good faith basis for disagreement and that he merits an informed response.  Or as we say in the mediation business, the rules of courtesy and respect will be enforced.  So…

Step One:  Perhaps to start here on this Blog.  It is appropriate to be critical of or even eviscerate a particular aspect of our current healthcare “system.”  But it is irresponsible to do so without also offering partial or complete solutions.  If you are smart enough to eviscerate something as complex as an aspect of healthcare, you also are smart enough to consider, evaluate, and propose solutions or paths to solution.  If you were my Vice President in charge of [fill in the blank] and came to me with a problem or a complaint, I would not hear you out unless you also offered its solution.  A not uncommon business practice.

If you were to do an informal sampling of blogs on healthcare, the angriest often are from physicians.  Understandable given what has been done to the profession over the past 40 years.  BUT…we all  know that physicians usually are the smartest men and women in the room.  They owe us and themselves more than bare criticism.  It IS their system.

Step Two:  People, whether elected officials, providers, insurers, consumers, or bloggers, should take strong positions on healthcare issues.  Commendable.  But there is a developing trend that when such people are criticized, they become immediately defensive and the quality of their responses (if any) suffers.  I have been guilty of just that.  But we have to move beyond that.  Our responsibilities to the “system” demand that we do.  We must take criticism as a huge opportunity to test out the validity of our position.  Welcome it.  It is your opportunity to take your theory out for a ride, albeit on a bumpy road.  Does it work?  Does it need fine tuning?  Maybe it’s good to find out whether you can (with facts and respectful dialogue) successfully respond to the criticism.  Assuming the good faith of the critic for the moment, others may well harbor the same criticism.  Thus you have to deal with it.  Either the critic was wrong, partially right, or right.  Without respectful and thorough dialogue and exchange, you’ll never really know.

This issue is causing buzz.  Huffington Post has an article titled “How to Have a Rational Debate About Healthcare Reform.”  Its suggestion:

It’s easy to demonize those who disagree. We have to stop – right now. People who disagree with me or with you don’t hate America. Nor do they hate the poor. They don’t hate insurance companies, they don’t hate sick people, and they don’t hate capitalism. It’s a myth that only one solution is available or that we can’t disagree about what to do. We should debate this; we should argue with each other passionately. That’s what Americans do.

There was a great 1980 song by Pat Benatar called “Hit Me With Your Best  Shot.”  Appropriately released on her album titled “Crimes of Passion.”  It might be our new anthem in the healthcare dialogue. A welcoming of your best shot (delivered respectfully with positive suggestions to correct) such that I may be better informed.  That I may be saved from a mistake.  That I may write a better article or make a better proposal next time.

I earnestly hope this didn’t sound overly preachy.  But too often I don’t see the constructive back and forth amongst clearly qualified commentators with the goal of reaching a better position.  Perhaps not complete agreement, but a clearer view.