Is it possible to have a rational discussion about health care reform? On some level, the answer is yes. I’ve observed and participated in conversations that are smart and thoughtful and that manage to stay respectful,Â even when people don’tÂ agree with each other.
But when it comes to a national conversation, color me doubtful.
Only a year ago we were in the midst of an extremely heated presidential election campaign. In virtually every poll, health care was one of the American public’s top concerns. There was a sense at the beginning of 2009 that maybe this was the yearÂ health care reform would finally happen. There was momentum; there was support.
NowÂ that we’re on the edge of the cliff,Â though, we’re balking. Apparently it’s one thing to talk in abstract terms about the need to make health care more accessible and more affordable to all Americans.Â Getting down to the details about how thisÂ might actually be accomplished seems to be another thing altogether.
Blogger Bob Doherty at the American College of Physicians explores this ambivalence among the public and comes up with some insights:
What people want is unlimited health care, paid for by someone else, at no cost to them. What they need is access to care that is reasonably affordable, with some limits to ensure that the total price tag doesn’t bankrupt the country.
It is the “limits” part that has people upset. They instinctively understand that health care reform will involve some limits on their own care, even as health reform advocates try to sugar-coat things by saying it can all be paid for by reducing waste and fraud and promoting “value” and “efficiency” in health care. We can deny all we want that health care reform will lead to rationing, yet much of the public believes that in the end, the government will put limits on the care they want.
In other words, we understand some compromises need to be made, but few of us want to be the ones doing the compromising. And like a hedge of thorns, it’s the snag on which we continue to stick, Doherty writes.
I think the president has not squared with the American peopleÂ that it isn’t possible for everyone to get everything they want. But the critics of his efforts have also done a disservice by screaming “rationing” every time the discussion turns to controlling costs.
The issue, in my mind, is not whether there will be limits – call it rationing if you must,Â although it is such a loaded term. Instead, the question is who will do the rationing and how.
Doherty isn’t the only one asking the question. It also was raised recently by doctor-blogger Kevin Pho, with a slightly different twist: the tendency of patients to want tests and treatment even when all the available evidence suggests it’s not necessary or that it’s unlikely to confer any medical benefit.
“There’s a fundamental belief in our society that more medicine equals better care,” Dr. Pho writes. Squaring this belief with the need to accept the limits of what medicine can doÂ seems to be extraordinarily difficult for many people.Â This disconnect between wants and needsÂ hasÂ become a major underpinning of the larger discussion on rationing or limiting care.
It’s interesting to note that the Kaiser Family Foundation’s most recent tracking poll on health care reform shows that public support was up a few notches in September. Maybe people have gained some distance from the contentious town hall meetings during August and have had time to reassess their opinions. Maybe there’s a renewed sense of momentum. Maybe it’s just a statistical fluke.
By all accounts, the Senate Finance Committee will have a health care reform bill ready for a vote by this weekend. Anyone who was around in 1992 probably remembers the last time we got serious about health care reform. The effort crumbled into failure. In the ensuing 17 years, this is the closest we’ve come to attempting onceÂ again to making some meaningful reforms in health care. Arguably we need it even more now than we did in 1992. The question is whether we’reÂ ready to want or accept what it might entail.
When you get right down to it, we all seem to holdÂ slightly differentÂ views of whatÂ health care should be. Health care, after all, is very personal. Someone with a chronic disease experiences the health care system in an entirely different way from someone who’s never been sick a day in their life. What the old want for their health care is different from what the young want for theirs. When you toss individual values, beliefs and political ideology into the mix, it gets even more emotional and complicated.
I’m pretty sure there’s some common ground here, but it’s hard to find when so many of us can’t talk rationally about it. And rational discussion is what we need, even if we don’t really want it.
West Central Tribune photo by Rand Middleton