23 March 2010

Health System Reform?

The bill was signed today. The Republicans are offering amendments in the Senate, which will likely be futile. Was this really health system reform? That was the initial goal, but ended up as health insurance reform. Was the change in nomenclature simply a change in course to only reform one part of our system? Or was it just a cloak, a change in the title instead of the substance, to settle down the masses? Our entire system needs reform.

Where were the medical liability reforms? Where was the change from an employer-based system, to a system of individuals buying portable insurance? Where was the overhaul to allow Medicare to negotiate with pharmaceutical companies for cheaper drugs? Not only did we not just accomplish health system reform, but we did not accomplish it in the manner promised us by the candidate Obama.

Worse than anything, watching the debate on C-Span Sunday night made me think - this was not the way it was meant to happen. Democrats ignoring Republicans. Republicans shouting on the House floor. Instead of legitimate open-minded debate, we saw political theater at the primetime showing. Democrats wrote the bill with little Republican assistance, and there was little teamwork to produce this sausage.

Some of my fondest memories throughout my medical training have come during heated debate at American Medical Association meetings. The back-and-forth, usually led by my liberal-leaning fellow medical students and physicians-in-training, and generally enhanced by the fatigue that comes from a day of discussion and panels and meetings, topped with a touch of wine, generally led to a powerful consensus: Our healthcare system needs a life-saving operation. While the views of my friends out in the pacific northwest typically didn’t align with those of my own more conservative camp from Texas, we almost always found common ground. Each time we ended with a heightened sense of mutual respect for the others’ views and goals, and our friendship grew. What harmony.

Where was this agreeable attitude amongst our Congress? Have the last few administrations and elections, and most importantly the media, this effectively polarized our country and its leaders?

In the end, what are we left with? Health system reform (or was it health insurance reform?) that was passed - squeaked by the House, and Reconciliation that will survive the Senate only with the help of the Vice President’s vote. And to slap the exclamation point on the end, the Vice President demonstrated powerfully just how much of an accomplishment he felt this was.

This entire debate has left me confused about what “side” I’m on in this debate, in this polarized country, where everyone is forced to choose. Black or white. For the uninsured or against the uninsured. For lawsuits or against them. Expensive medication or cheaper medication. Tax Cadillac insurance plans, or not. And finally last night I was asked, “Can anyone really be just ‘for’ or ‘against’ healthcare reform?” Brilliant question.

No. The answer is no.

The 2700-page bill, the health system, the debate, has many aspects, many working parts. You can support parts, and want revisions to others. Truthfully, our system needed a change. Not only a facelift, but a transplant – in most areas. We needed drastic changes, but in this climate severely lacking in compromise and the ability to work in the grey zones, this wasn’t politically possible. (Whether that’s the media’s fault, or the fault of the politicians themselves, I’ll let you be the judge.) In the end, I want what’s best for the patients in our country. I want for everyone to have access to quality healthcare. And if that makes me liberal, then I guess I am.

And finally, my favorite quote from the grand finale Sunday night comes to us from Paul Ryan, Republican from Wisconsin: "The philosophy advanced on this floor by this majority is so paternalistic and so arrogant - it’s condescending.” This debate has forced me, and many of us, to reach deep down and ask what we believe and why we believe it. At my core, I believe the government is not itself the answer to our greatest problems – and if that makes me conservative, then I guess I am.

So, if you’ve had trouble picking between the two sides in this debate, don’t worry: You don’t have to, and you’re in good company.

1 comment:

  1. I appreciate your observation about the size of the bill. There are many interdependent pieces and nobody has to be all-for or all-against.

    I also agree that the lack of meaningful dialog at the political level was disappointing... and I think we see the effects of that throughout society.

    I think Ryan's quote, like the many others that came from Sunday nights debate, is rhetoric.

    My observation as of late is that information (accurate or not) travels faster than ever via the internet, email, social networks, the millions of niche channels we now have available on our TVs. Unfortunately, our politicians have yet to rise to the occasion by providing the clear, concise information society needs to understand and have meaningful debates on the topics. All we have is the opinionated rhetoric of our politicians and the (often uninformed) political extremists.

    I appreciate your blog. Cheers.