Saturday, July 4, 2009

Reform delays, costs - Is The Devil in the Details?

As the health reform debate roars on, and Independence day has arrived without any detailed reform bill, these questions arise. Is the devil in the details? Or is the devil in failing to pass a reform bill because of lack of details?

I raise this question because the July 4 edition of Politico reports a health care insider of saying the following about an Obama phone call to Democratic lawmakers before embarking on his Russia trip,”Obama made a very firm pitch that they need to get the bills out of the House and Senate, and we’ll worry about the details in September.”

In other words, to quote the “Come September” song lyrics, “Everything wrong gonna be alright come September.” In September, presumably, we’ll worry about Details. How much is this Thing going to cost? Will the government run a Thing called the Public Plan? How much will the bill dictate terms of the Doctor-Payment engagement, and who gets what and for how much? These are just details, of course.

Obama may be right. As the famous bank robber, Willie Sutton, remarked, “Success in any endeavour requires a single-minded attention to detail and total concentration.” Here that single minded attention seems to be getting the Thing passed and worrying about details later.

But unfortunately, as Alfred North Whitehead, the English philosopher, noted, “We think in generalities, but we live in details.” In general, it would be great to pass a reform bill, but we and future generations will have to live with the details.
Should we not sweat the details? Should we not worry about someone who can’t be bothered with details? Anyway, are details all that important as long as we do the Right Thing and get the Right Thing done?

Details, details. We’ll bother about them come September. After September, we'll worry about how much Independence remains for doctors and patients. But not this Independence Day, when we celebrate the Past.

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