Health Reform and its Aftermath: Time for a Civil and Truthful Dialog

March 28, 2010

Last week was a powerful and exciting week for anyone who cares about health care in this country.  Whether you agreed or disagreed with the specifics of this legislation, there was common agreement that the Patient Protection and Affordable Care Act of 2010 was momentous legislation. I do support the legislation, not because I think it is a perfect bill but because I think it is an important foundation to work from.

Despite the claims of critics, this is not radical legislation.  Indeed, it is a uniquely American piece of legislation: it works within the current structure of health care rather than replacing it.  Setting aside the rhetoric, this bill respects American traditions while making health care part of the social compact. The legislation is a mix of market approaches and public approaches: it is by no means a government takeover of health care (was Medicare a government takeover of health care? oops, I digress).  The legislation keeps in place provider choice, insurance choice, and the private delivery system of health care.  It doesn’t fundamentally change our drug development system, our medical education system, or our public health system; it does build on and modify all of those systems. Indeed, the criticism of many policy analysts is that the legislation actually doesn’t change enough about the current health system.  But even the most ardent advocates for radical changes to the system came to realize that simply wasn’t going be politically possible.

There were incredibly moving moments over the past week– especially the bill signing.  But, it was also a discouraging week as untruths about what was in the bills continued to fester in so many places.  Reporters asked me why so many people seemed so worried and upset by the bills.  Unfortunately, I think the answer to that question has more to do with the politics of the legislation than the policy.  While there are certainly many who have legitimate disagreements about policy issues, there are also many who oppose the bill because they a have fundamental philosophical disagreement with the idea that health care should be part of the social compact.  Rather than simply owning that view (a view that is certainly at odds with that of most Americans), some resorted to hyperbolic claims and false statements about what was in the bill, using language designed to breed fear.  And, those falsehoods come with a cost: they destabilize the public and de-legitimatize discourse.

Leaders have a responsibility to speak from truth and facts, not to frighten people with hyperbole.    The level of uncivil discourse has done a terrible disservice to the American people.  At a time of dislocation and insecurity, public officials should take pains to be thoughtful, honest and clear in their communications: to encourage meaningful and informed debate.  Instead, what we have seen has been inflammatory, confusing and playing to people’s basest fears.  This is the kind of discourse that led to the repeal of the Medicare Catastrophic bill of 1988 after Representative Dan Rostenkowski’s car was stoned by angry senior citizens.  While some who practice this type of rhetoric might hope for the same outcome in this case, they are misguided. Most health policy analysts believe the Medicare Catastrophic bill was actually a far better bill than the Medicare Prescription Drug, Improvement, and Modernization Act that passed in 2003, which took more than 10 years and an enormously complex approach to achieve less for millions of seniors.  Unbridled rhetoric has consequences: some, catastrophic.

The truth is, the bill signed by President Obama is neither perfect nor radical. It embeds the principle that health security should be a basic American right, while still embracing a market based system. These two goals have often been in conflict, resulting in the defeat of many previous efforts at health reform. This bill is big and complex and makes many compromises to balance those goals.

The truth is, this bill will help millions of Americans, and while it may not go as far as many would have liked on improving the cost and quality of the system, it goes further than ever before, further than the status quo was ever going to get us, and further than many predicted it could. So yes, there will be changes and fixes down the road.

But the truth is, we finally have a health policy in America to build upon. And that, in and of itself, is a good thing.