U.S. Healthcare Reform: An Acrimonious Divide?

Following this idea Open4Definition experimentally posed a series of four health or U.S. Healthcare Reform questions on LinkedIn - a business networking website. We selectively collected the most relevant replies from fifty answers and then returned this compilation to the answerers for their further input in a Delphi-like approach. The aim was twofold: first, to take a person-on-the-web opinion reading and second, to identify non-Open4Definition members motivated to break through the current logjam.

The last of these four LinkedIn questions follows.

Does America’s view of Healthcare Reform as ‘change’ explain the intensity of resistance? Often when ‘progress’ becomes rapid it is perceived as 'change'.

In response a new Open4Definition member, Bruce J. Gilbert wrote an unsolicited Op/Ed which we are delighted to share. Of course, further comments are also welcome.

Opinion/Editorial

In reading through the various LinkedIn answers to date, the reason for the 'logjam' becomes clearer. The quest for healthcare reform is caught up in the larger, looming political battle between the current administration and its detractors.

Look at the phrases used by the authors. "It all boils down to the opposition party doing everything it can to stall the President's agenda...If the goal is to "keep the insurance companies honest", forget it. Dishonesty is a fundamental part of their business model, and you will never eliminate it until they are gone....What is called health care is actually a massive control system that is being foisted on the American public. It plans to remove choices, freedoms and reduce quality by 'mandating' many of its policies." These types of statements do not allow us to frame a reasonable debate.

The political divide has becomes so acrimonious and the language of disagreement so heated and angry, so personal and corrosive, that we are all but ungovernable as a country. While it was once taken for granted that good and reasonable men may differ over issues, we find ourselves in an age where demonization of philosophical opponents has become the norm.

We are a country that prefers our change to be gradual. That's why we have an executive branch, a bicameral legislature, and courts with the power to overturn legislation which violates our constitutional precepts - a system built on checks and balances. We are a disparate group of states and interests that prefers to be governed by moderates rather than ideologues of the right or left.

To that end, the current administration would do well to listen to the ghosts of history. In 1994, Republicans were elected to a majority of both houses of Congress for the first time since 1953. This "Republican Revolution" foundered two years later when its leadership forgot that the purpose of government is to govern. When they allowed previously approved appropriations to expire on schedule, allowing parts of the Federal government to shut down for lack of funds, they breached their covenant with the public. They were sent to Washington to govern, not to shut the place down, and the voters made them pay for their arrogance.

Similarly, the current administration was elected on a platform of change, not revolution. Because the nature of the proposed reform is so far-reaching and pervasive, many people regard the effort with mistrust. The current proposal was crafted by politicians, not experts in healthcare. It includes a number of controversial and divisive matters like funding for abortions, government-sponsored coverage and insuring illegal aliens. The inclusion of these types of dissatisfiers, combined with a failure to address other perceived cost saving measures like tort reform, creates polarization and can be expected to generate a whiplash effect at the polls in the midyear elections.

It would be wise to remember that having sixty votes today in the U.S. Senate is not the same as assuring the continuing viability of reform efforts. Laws can be repealed. Courts can invalidate portions of enactments or entire legislative schemes. By defining healthcare reform as a political problem requiring a political solution, we diminish the opportunity for reasoned discourse, the reaching of consensus and the adoption of a popular and centrist solution.

Copyright © 2009, Bruce J. Gilbert

Bruce J. Gilbert is the Principal of Southwestern Risk & Brokerage Group, an insurance and employee benefits consulting service in San Antonio, Texas, USA. He has considerable experience in the trenches of healthcare administration having recently directed the State of Ohio’s employee benefits programs covering 63,000 employees. Welcome aboard Bruce!

Two related projects are underway -- see open4definition.org/projects.php -- in this arena.

A Redefinition of Health and Healthcare     Applying WHOlistic Health Locally

Open4Definition is an all-volunteer organization, which is an added advantage in the mire and political quicksand of healthcare; at least in the initial stages. We are apolitical and also the first 'Local' Health Implementation Project is underway in Coweta County, GA. There is moreover interest in creating other parallel 'local' health implementation projects across the U.S. If this intrigues you, please let us know.

There is in addition a sixteen page Case Study titled The Health & Healthcare Definition Team Report plus a thousand-word complementary and a more general Research Review about definition-form stories that covers a wider spectrum of applications.

Finally, three other intertwined LinkedIn questions were also asked in November/December, 2009.

• Should wasteful medicine be profitable? And how can we decide what is and isn’t wasteful?
• Will U.S. Healthcare Reform tackle the right issues?
• Good health is…