Friday, October 14, 2011

Health Reform and Political Musical Chairs

Every boy and every gal
Who’s born in this world alive
Is either a little liberal
Or a little conservative.

Gilbert and Sullivan Song

Your proposition may be good
But let’s make one thing understood
Whatever it is, I’m against it
And even when you’ve changed it or condensed it
I’m against it.

Groucho Marx, Horse Feathers

October 14, 2011
– We’re all a little liberal, and a little conservative, but you would never guess it from the current political musical chair game.

The game goes like this. The music starts. Liberals, conservatives, and moderates circle chairs. The music stops. Liberals and conservatives grab their chairs. The moderate is left standing.

No chairs remain for moderates in political discourse. For example, you’re either for or against Obamacare. In June 2012, the Supreme Court will decide who gets their chairs.

Health reform musical chairs makes little sense. American health care has always been a partnership between the public and private sectors. Today government programs cover 100 million Americans, private plans 200 million. Government laws say hospital ERs must accept all comers. Private physicians and institutions care for those in government plans. Medicare, in concert with the private Reimbursement Update Committee, sets physician fees. The public overwhelmingly supports NIH and academic research and physician training expenses. We endorse the VA, the largest hospital system in the Western world. We support government-subsidized community health clinics, which care for 20 million Americans.

And so it goes, the intimate intermingling of the public and private sectors.

Americans like it that way. Eighty percent of us like our private plans. We expect Medicare and Medicaid and Tricare to pick up the slack. We like quick access to high tech medicine – stents, angioplasties, hip and knee replacements, organ transplants, artificial cataracts with related devices, dialysis, and wonder drugs – and to the private doctors who administer or perform them.

We like the diversity of care systems in this vast diverse continental nation - Kaiser in the west, Mayo and Cleveland Clinics in the Midwest and beyond, Giesinger and the Boston Medical academic complex in the East, and private and academic systems everywhere.

America is a decentralized, centrist, conservative society that resists radical political policy swings. We welcome federal entitlement programs, but not at the price of roaring deficits and soaring taxes as far as the eye can see or the mind can imagine. And we are deeply suspicious of one-size-fits-all national solutions that compromise individual freedoms or smack of ”socialized medicine.”

Still we like simplistic solutions expressed as sound bites, whether shouted by the left or right, the Tea Party or the Occupy Wall Street Crowds. 9-9-9 appeals to us.

We dislike moderates who speak in nuances, or in hushed tones about compromise at the margins, much less in the middle.

The perception of Mitt Romney as a moderate is problem among conservatives. Romney has the audacity to change his position in changing times, whether it be Roe v. Wade, or health care. After instituting Romneycare,he now says that each state ought to have the option of creating its own health system, that you can simultaneously be a social liberal and fiscal conservative, and that health care is too complicated for simplistic solutions.

Last night I was listening to a PBS documentary, “The Unseen Alistair Cooke.” Cooke was a Cambridge-educated Englishman turned American citizen. He loved, understood, and relished America - our contrariness, our independence, and our love of individual freedoms.

From 1932 to 2004, when he died at age 95, Cooke crisscrossed America, by train, plane, and car, while explaining in Letters from America to his English brethren, what America and Americans were really like.

In his book Alistair Cooke’s America (Knopf, 1974), he had this to say about his adopted land.

It is a bitterly, and sometimes rousing, complicated place, this land thrashing over such incessant contradictions as control and permissiveness, the radical young and the conservative middle. The limitlessness of civil rights and the limitation of presidential power. ..While the American tradition is conservative, what it has struggled to conserve are often very radical indeed.

A still more timely reminder that the government of a free people is meant to be argued about comes form the most famous of American jurists. It gives me, at least, some hope in the outcome of our present conflicts. It is that tremendous line of Justice Oliver Wendell Holmes: A Constitution is made for people of fundamentally differing views.

A moderate wrote that passage. He kept his chair in the game of journalistic musical chairs for 74 years. We can learn something from him: moderation is no vice. It deserves its musical chair at the table of national and health care politics.

In today's political musical chair game, there is no room for moderates like Romney, only for extreme liberals or conservatives

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