Politics and egos: Can we compromise?
Rocky Mountain News
January 30, 2004
Politics blamed for impeding health care
By Rachel Brand
Health insurance for all Americans is again likely to become a presidential campaign issue…
Support for the issue is “a mile wide and an inch thick,” said Ron Pollack, who spoke at the conference, which was sponsored by Health Affairs, a leading policy journal. Scratch deeper and you’ll find the issue rife with political gridlock, moral posturing and wary voters.
“Up until now the issue has been about altruism for a discrete part of the voting public,” said Pollack, executive director of Families USA, a consumer group. “It needs to be viewed as an issue of self-interest for middle-class, working families.”
Pollster Robert Blendon, professor of health policy and political analysis at the Harvard School of Public Health, said Americans increasingly are concerned about what would happen if they lost their insurance. They also support plans to help the uninsured, from tax credits to expanding public programs.
Yet that support drops dramatically when they’re told the cost of programs. “When you read voters a list of policies to cover the uninsured, they say, ‘Hey, let’s have it,’ ” Blendon said. “But if you make a single negative argument, it sinks their confidence.”
Blendon recommends that policy-makers embrace plans that include elements of
tax credits, expanding existing programs, and a few employer and individual
mandates, saying it would be less vulnerable to criticism.
Pollack and others said politicians need to get their egos out of the way. In years past, if their policy wasn’t adopted, they’d walk away without trying to compromise.
http://www.rockymountainnews.com/drmn/business/article/0,1299,DRMN_4_2615598,00.html
Comment: Blendon and Pollack again make the plea for compromising, while reiterating their long-standing opposition to uncompromising,ego-driven advocates (single payer advocates?).
Yet, Pollack, and to some extent Blendon, have been uncompromising in their
advocacy for their very specific model of reform: employer mandates (perhaps
with individual mandates), tax credits, and expansion of public programs
(especially Medicaid and S-CHIP). Their model has been analyzed extensively.
It is the most expensive model of reform at a time when affordability is the
number one public concern about our health care system. Their model also
falls short on comprehensiveness, equity, and even on universality. In contrast, the single payer model is the least expensive and most comprehensive model that does ensure true universality.
Is this the time to abandon discussion of fundamental health policy principles that might shed some light on the problems and potential solutions? Should we walk away from our great body of health policy science and follow the dictates of ego-driven individuals (as we all are) who have labeled their favorite model a “compromise,” when it is just another specific model in the list of options?
Is compromise the solution? Ignoring health policy science is not compromising, but it is abandonment of valuable tools that should be used to craft health care reform. We shouldn’t accept less than universality, comprehensiveness and affordability, which means that we shouldn’t compromise with special interests that would sacrifice these goals for their own benefit. That would not be compromise; that would be a cop-out.
Where can we compromise? How about compromising on the process? Actually,
we’ve already begun to do this. Cover the Uninsured Week, sponsored by the
Robert Wood Johnson Foundation, has already brought together diverse interests that now agree that we must provide coverage for everyone. That’s a crucial first step. And that was the easy part. But now we must encourage the special interests that have permeated this process to join in a sincere and dedicated effort to make this a reality.
It is time for each interest to decide how much of a compromise can be accepted on its own part to attain this universally-agreed-upon goal. The process should not allow compromise of universality, comprehensiveness and affordability, but rather it should be directed to negotiated compromises made between the various interests involved. Funding should be equitable, which means that we need to negotiate between businesses, individuals and the government the means by which the greatest equity could be achieved. Insurers must negotiate an end to their profound administrative waste as they transform themselves into essential health care partners by providing much-needed services such as an integrated information technology system (in partnership with the National Institutes of Health and the National Research Council). Health care providers should negotiate the establishment of a process that will cover their expenses while still providing a fair profit, and agree on a reasonable method of allocating resources.
We can provide affordable, comprehensive care for everyone, and we shouldn’t
compromise on that. But all interests need to sit down at the negotiating
tables and begin an open process of compromising on each of our own interests. The $1.6 trillion that we are already spending is enough to go around. Let’s negotiate a compromise on how we should spend it. After all, it is for the benefit of our patients. And isn’t that what it’s all about?
http://covertheuninsuredweek.org/