Health Reform and Senses of Community

We are a nation of communities, of tens and tens of thousands of ethic, social, business, labor union, neighborhood, regional and other organizations, all of them varied, voluntary, and unique...a brilliant diversity like stars, like a thousand points of light in a broad and peaceful sky.

George Herbert Walker Bush (1924- ), Acceptance speech, 1988

June 20, 2011- I awoke this morning asking why two of the Republican presidential candidates are Mormons – Romney and Huntsman – and why two are Minnesotans – Pawlenty and Bachman.

My answer is that Mormons and Minnesota both have a strong sense of community.

As a religious group, Mormons have created a unified, purposeful, and successful business, social, and community enterprise. They have shown a missionary zeal for the common good can go a long way. Mormons even have a sense of humor, as the present Broadway play, The Book of Mormon, demonstrates.

As for the Minnesotans, they too have a strong sense of community. I lived and practiced in Minnesota for 25 years. I was struck by their traditions of group practice, their organizational abilities with the creation of 34 multinational businesses, and their policy in the Twin Cities of giving 5% of corporate profits to the Arts. Maybe these cultural things sprang from the history of farm collectives, or simply from their survival instinct of huddling together to warm themselves.

President Obama’s instincts are those of a community organizer. That is how he made his name in Chicago. Now he seems to think in terms of the United States as a community to be organized from the top-down, and of the United States as an equal but not pre-eminent member of the world community.

But there are hazards of bringing all communities under the umbrella of one unified community, to be governed from the top down. We are a nation of multiple communities – ethnic, religious, social, business, and professional – each with a specific purpose.

In the case of ObamaCare, the government’s team of policy experts is a community, with similar managerial expertise, and a belief that a restructured health system, guided by comparative effectiveness data and cohesive hospital-physician organizations, are the path to a better health system.

The nation’s physicians are a community too – with a huge capacity for innovation, long periods of training, and a shared professionalism. As a community of professionals, physicians feel government policy makers have ignored their input.

That may be why the level of discontent among practicing physicians is unprecedented, why distrust of government is so high, and why AMA membership is so low. The AMA endorsed the Accountable Care Act, and its provisions, like rules and regulations on physician compliance and individual and state mandates. This endorsement has not played well with the AMA’s constituency of private physicians.

Among communities in a Democracy, mutual respect is essential, and that has been lacking in governmental-physician relationships.