Sunday, December 13, 2009

Comprehensive Reform: Still Too Much Change to Believe In

Four years ago, I wrote Voices of Health Reform (Practice Support Resources,2005). The book consisted of interviews with 42 national health leaders. From those interviews, I concluded national reform – i.e., single payer – would not occur soon. U.S. culture was not and is not there yet.

In the course of writing the book, I ran across two statements about American culture that stood out.

• ONE was by Victor Fuchs, PhD, Stanford health economist, and Ezekial Emanuel, MD, chair of clinic bioethics at NIH and now President Obama’s chief medical advisor, “What might set the stage for comprehensive reform of health care? A major war, a depression, or a large-scale civilian unrest might well set in motion a change a change in the political climate that would overpower the obstacles that prevail in normal times.” (“Health Care Reform; Why? What? When?" Health Affairs, 24 No. 6(2005), 1399-1414).

The U.S. now has a war, but it is not a major one, at least not a world-wide conflagration ; we have a recession, but it is not a depression; and we have moderate civilian unrest but not marches or riots in the streets over health costs and access. The U.S., in other words, has not yet reached the tipping point calling for comprehensive reform. The U.S., with its government system of checks and balances, is inherently resistant to radical change of any kind - economic, social, or political- and radical health reform embodies all three kinds of change.

• TWO, quoted in my book, was an answer by Garry Orren, a professor of political science at Brandeis, who regularly polls for the Washington Post and the New York Times. When asked what was unique about American culture, Orren remarked, “ A good place to start is to remember we are pro-democracy and anti-government. It comes down to ideas that are essentially anti-authority and self-regulatory. It there were an American creed, I think it might begin.

One: A government is best that governs least.

Two: Majority rules.

Three: Equality of opportunity.”

As I view the current reform scene,

One: polls indicate only 35 percent of Americans approve of current health care reform bills, i.e., they distrust government.

Two: Democrats rule, but the margin of overall Obama approval is only 52 percent and Congressional approval 27 percent, i.e., the majority rules but shakily.

Three: Americans approve of “equality of opportunity,” ie. everyone ought to have access to health care opportunities, but not necessarily of “equality of results,” i.e, a redistribution of equal benefits to all.

American culture shapes health reform. This culture distrusts massive government change, and it has not yet seen change, to use President Obama’s phrase, “we can believe in.”

Dr. Richard Reece is author, blogger, speaker, and innovation and reform commentator. Dr. Reece’s latest book, Obama, Doctors, and Health Reform ( is available at www.iuniverse and other book websites. For information on speaking fees and arrangements, call 860-395-1501.

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