Sunday, March 27, 2011

In Praise of Politicians on the First Birthday of Health Reform

President Obama's health-care reform celebrated its birthday last week but not very happily. Republicans, who gained control of the House last fall in part by attacking the reform, redoubled their threats to strangle the 1-year-old in its crib. Democrats defended the bill but, well, defensively.

Washington Post Editorial Board, “The Politics of Health-Care Reform on its First Birthday,” March 26, 2011

The politics of health reform is a rough, tough game. Politics is not patty-cake. You can please some of the people some of the time, but not all of the people all of the time. You may please your constituents, but you antagonize your opponents.

That may be why most of us look with universal disdain and down-our-noses at politicians. Almost to to a person, we say politicians advance their own interests, rather than those of the people. If you regularly read the Washington Post, you might conclude the Left is right, the Right is bereft, and never the twain shall meet.

Not me. I look upon politicians as professionals and politics as an art, just as practicing medicine is an art and a profession. The late Felix Frankfurter (1882-1965), a Harvard Law Professor before he became as a Supreme Court Justice, said it well:

“Government is itself an art, one of the subtlest of the arts. It is neither business, nor technology, nor applied science. It is the art of making men live together in peace with reasonable happiness...And that is why the art of governing has been achieved best by man to whom governing is itself a profession.”

In my book The Health Reform Maze, now at the publishers, I take the position that politicians, Democrats and Republicans alike, have good intentions. Each political philosophy, however, has unforeseen consequences. Democrats seek universal coverage, but at fearsome costs and massive bureaucratic intervention into personal health affairs. Republicans seek more personal freedoms and choices, but at the price of limited coverage and runaway costs.

Still, both parties act in the best interests of their constituents, in their own self-interest, and in the interest of their own political philosophies. They believe they act in the best interests of the nation. Politicians are, after all, human beings with strengths and weaknesses that beset us all. They should be praised for standing up to their beliefs, rather than being condemned for their shortcomings.

Massachusetts politicians and politics are a case in point.

• Milt Romney, who was governor when the Massachusetts universal coverage law passed five years ago, thought he was acting in the best interests of the people of Massachusetts when the law passed. It was, and is, a popular law in the Bay State. Yet, because the law is considered a paradigm for the national health reform law, because Massachusetts is considered a far-left state, and because its health plan’s costs are proving prohibitive, Romneycare may well bring Romney down as the Republican presidential candidate.

• Republicans are using the defects of the Massachusetts law as a potent campaign issue against President Obama. Curiously, though the majority of Massachusetts residents favor the law, exits polls after the victory of Republican Senator Scott Brown, indicated voters were against expanding Romneycare to the nation as a whole.

• There’s the dilemma of Dr. Donald Berwick, who President Obama appointed as CMS administrator. Berwick is not a politician, but a victim of his politics. He has well-earned reputation as a crusader and implementer of hospital safety and quality measures, but because of his outspoken advocacy of government-led health care and his disdain for market-directed care, he will most likely not be reappointed as CMS administrator.

• Not all Massachusetts advocates of health reform are political, of course. Many reform ideas transcend politics. Examples are ideas of three professors at Harvard Business School. 1) Michael Porter’s prescription for reform is competition sparked by distinctiveness, open choices, and transparency; 2) Clayton Christensen’s reform vehicle is “disruptive innovation” featuring lower costs, convenience, and performance by lesser trained, less- sophisticated personnel; 3) Regina Herzlinger’s formula revolves around consumer-driven health care wherein informed and responsible consumers make smarter choices, just as they do in other retail markets, such as computers and automobiles.

Politics is a dirty business, but someone has to do it. Politicians who do it should not be universally ostracized, criticized, chastised, despised, compromised, and sensationalized for their faults. They have a job to do, and they do it as they see best. We should respect them for that.

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