Thursday, November 20, 2014

Health Reform: It’s The Diversity, Stupid!

It’s the Economy, Stupid!

James Carville, President Clinton Adviser, 1992

Since James Carville created his 1992 slogan, political slogans ending with “Stupid!” have gained political currency.

“Stupid!” is usually a positive rallying cry, but since Jonathon Gruber said ObamaCare passed because of the stupidity of American voters, Republicans claim “It’s the Stupidity, Stupid!” is one reason ObamaCare passed. We are a nation of whites, blacks, browns, yellows, blues, and reds, and it wise to be color blind but to keep in mind whites are still a majority of the mix.

“It’s the Diversity, Stupid!” would be a more appropriate reason why ObamaCare is faltering and may fail.

Previous Presidents have hailed diversity. John Fitzgerald Kennedy said in a 1963 address,” If we cannot end our differences, at least we can help make the world save for diversity.

In 1988, in his acceptance speech, George Herbert Walker Bush declared, “ We are a nation of communities, of tens and tens of thousands of ethnic, religious, social, business, labor unions, neighborhoods, regional and other organizations, all of them varied, voluntary and unique. A brilliant diversity spread like stars like a thousand points s of light in a broad and brilliant sky.”

When President Obama and Democrats passed ObamaCare, they made a critical mistake. They ignored diversity. The passed the law against unanimous Republican opposition and majority public opinion.

They forgot about diversity – the mainspring of American democracy. They forgot the majority of American people rule. They forgot we are a nation of the balance of constitutional powers – checks and balances, center right versus center left.

This forgetfulness may be why ObamaCare is in such danger. It caters the left while ignoring the right. It gravitates towards government control, away from private contributions. It does not acknowledge we must balance excellence, access, choice, and cost.

This balance is fragile. I wrote about it nearly ten years ago in a now forgotten book , Voices of Health Reform: Options for Repackaging American Health Care (Practice Support Resources, 2005).

The book featured interviews with 42 major health care stakeholders.

It ended with this overall conclusion,

“Our health system is a creature of our culture. When asked what Americans believe, Gary Orren, a professor of political science at Brandeis, who polls for the New York Times and Washington Post, said,

“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 tend towards self-regulation.

‘If there is an American creed, it might begin.

One, government is best that governs least.

Two, majority rules.

Three, equality of opportunity.’

“This seems about right to me. It explains why Americans prefer local health systems, why they reject federal government-mandated universal coverage with rationing, why they prefer they prefer pluralistic payment systems, why they allow market-based and public-based institutions to co-exist and compete, and why they permit doctors to behave democratically, seeking their own locales to practice, often acting independently of hospitals, health plans, and government, and making their own decisions , free of fetters of others.

Democracy is a messy business.”

President Obama, when unilaterally passing laws or issuing executive decrees, should keep in mind the American creed, culture, and diversity.

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