Tuesday, September 3, 2013

An Emotional Understanding of Health Reform
What is going on now, clearly, is a deeply and frequently moving examination of the emotional significance of this most profound of all our national experiences. We are not yet wholly rational beings.  We approach true understanding through our emotions rather than through  our intellects, deplorable as that may be...
Bruce Catton,  Prefaces to History, Doubleday & Company, 1970
Bruce Catton was writing about the American Civil War.  Today he might as well have been writing  about the American  Health Reform Divide.   This Divide is not a war, but it is  a profound disagreement about the role of government and the preservation of the health care union.
The Reform Divide has divided Americans across partisan lines.   One side wishes to form a uniform government system for all Americans, the other to preserve and perpetuate independence and choice for all Americans. 
On both sides it is a struggle for freedom – for unity on one hand and diversity on the other.   Reform on a national  and regional scale is so complex, so emotional, so far reaching that it is a matter for emotions rather than cold factual analysis.   It is hard, if not impossible, to reach a balanced judgment – to be judicious, fair-minded, nonpartisan, and unemotional.
On the liberal and progressive side,  it is a fight for freedom of access,  to be free of fear of bankruptcy from health costs, to provide affordable care, to protect the vulnerable.    It is about leveling the playing field,  for equal access to care,  courtesy of the federal government.   Although it is unsaid,  it is also a struggle for political power in the belief that  people will never forget what the government has done for them.  But beyond that.  It is a moral imperative to establish government sponsored and guaranteed health care as a basic right for all, not as  a privilege for the affluent few.
On the conservative, dare I say constitutional, side, it is a fight for preserving a way of life and traditional established practices,   for a balance between government and private interests,  for the power of individuals  to innovate from the bottom-up rather than the top-down , for the freedom of choosing options - your doctor, your health plan, your hospital, and your own  way of paying for it.
Both sides agree the poor,  the ill,  and those unable to pay should be subsidized.  But by whom?  By the federal government or by the states? By charities, churches,  all taxpayers,   bureaucrats, or plutocrats? And at what level?   Primary care for all?   Specialty care for all? Or the latest and best and most advanced care for the few?   With the Internet and universal connectivity,  one  can no longer unemotionally  isolate these points of view.
And how to rationalize it all?   At this stage, the government has chosen to make it all seem rational by declaring medicine a science rather than an art,  by using computer-generated data to judge what constitutes evidence-based care,  to manage the process by paying for performance  and predictable outcomes,  to say only  policy experts  know what is best for the people, who are not responsible or informed enough to do it on their own.
But surely say those on the ground, on frontiers of care, in workplaces, homes, offices, operating rooms, clinics,  and in their hearts and minds,  and among family members, people think they know what to choose and what care is better care,  what suits them, what they can and cannot afford, and what they, not the government,  should be responsible for.   It is not either/or,  the government or me, it is multiple choice. It is an emotional , as well as a rational choice.

Tweet: National health reform is an emotional, not strictly a rational,  issue. It is a matter of the heart as well as the head. 

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