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HEALTH CARE: Liberty, Justice ... and Politics
The Hastings Center recently published a series of articles on American values and health reform, including one on stewardship by New America's Len Nichols. Hastings has now created a related web site and blog, The Values and Health Reform Connection to expand the conversation. They invited me to write one of the inaugural essays, "Honest Debate - and Pragmatic Solutions." I wrote about values and politics (not as synonyms) and honesty and quality. (I think working moms by nature and necessity tend to find themselves pondering the practical side of things more than the ethereal and philosophical) I'm cross posting below. Other early contributors include Maggie Maher, "Dr. Val" Jones and William Sage. Hastings also invites your comments and contributions, as do we.
Liberty. Justice, Responsibility, Solidarity.
These are some of the American Values highlighted in the Hastings Center's report on "Connecting American Values with Health Reform."
Watching health reform unfold here in Washington, however, that "Connection" is painfully elusive. The debate is not a careful calibration of competing rights, values and obligations. It's a political moshpit. Instead of values, we have vitriol.
Outside of Washington, even extremely astute people ask me why we can't fix a health care system that is inefficient, inequitable and downright inexplicable.
I patiently explain that this fight is not purely about policy (or values). Health policy becomes a gritty proxy for politics.
Values, or at least ideology -- particularly about the size and reach of government -- play a role in politics. But an awful lot of what passes for policy debate is trench warfare before the next election. Look at the list of amendments proposed for any of the major bills -- and ask yourself how many are meant to improve the health and well-being of the American people and the American economy, and how many are meant to score points, woo donors, placate interest groups and create a C-Span moment.(Both parties do this, particularly while in the minority; theatrics is the next best thing to votes.)
Still, for those who believe (as President Obama tells us) in a moral imperative to cover the uninsured and create an economically sustainable health system, it is tempting to indulge in a little values-imbued wishful thinking.
What would the health reform debate look like if, as Thomas Murray wrote in the introduction to the Hastings essays, values were the "beating heart of health reform?" What if the health care debate truly was aimed at realizing our national vision of "liberty and justice for all"? What would it look like if we dropped that vitriol, and returned to values? If, as Dr. Murray wrote, we centered on this simple core idea:
Everyone should be responsible for participating in whatever way is appropriate. When anyone needs health care that is reasonably effective and not financially ruinous, the care will be there for them.
To have such a conversation, the first requirement would be honesty. I'm not sure if it's Jeffersonian, Hamiltonian or Jacksonian but I certainly like to think of honesty as an American value.
If we were honest, we'd still have genuine and perhaps unbridgeable differences about the public plan, or the level of subsidies or the practicality of certain models of care.
But we wouldn't be screaming about death panels, abortion mandates, illegal immigrants, taxpayer funded sex change operations and a government takeover of health care.
If we were honest, we would reach beyond bipartisan platitudes about a broken system and acknowledge that there is no such thing as the status quo in health care. Our system gets a bit more broken each day, and all sectors of society bear the cost in incalculable (and inequitable) ways..
If we were honest, we would stop talking about "consumer" and "providers" buying and selling goods and services in a rational market. We'd talk about patients and families and doctors and nurses, and understand that health care is not a "commodity" in the usual sense of the word.
Above all, we'd stop talking about how health reform is going to bring a scary heartless bureaucratically-induced rationing - and recognize that we are already rationing. Only we ration irrationally, in unkind, unfair and unscientific ways. Our surest path to deeper and coarser rationing - the Medicare equivalent of slash and burn - is to do nothing.
That brings me to two of the final "Connecting Values" essays -- Quality and Efficiency. Both are concrete and pragmatic, less abstract than liberty or justice. But in health reform, they may be our salvation. We don't, after all, have a Congressional Justice and Fairness Office "scoring" health legislation. We have a Congressional Budget Office - and budgets may reflect our national values and priorites more than our shouted political discourse.
So rather than having two stark choices (taxing more or cutting benefits -- aka rationing) we have a third path, that budgetary nirvana of delivery system reform, realigned payment incentives and comparative effectiveness research. New ways of delivering care, including a renewed emphasis on treating the frail and the chronically ill in the community instead of in the ER and ICU. New models of shared-decision making, and more and better palliative care, both of which may change how patients and families weigh when to reach for the brass rings of modern medical technology, when to give chicken soup and Tylenol a try, when the time has come to seek a gentle end.
Maybe in 10 or 15 years from now, we'll be back to shouting. Maybe these new models - accountable care organizations and multi-specialty physician group practices and advanced medical homes and concurrent care - will turn out to be one more set of next best things that weren't so good after all. Maybe we are fooling ourselves when we listen to the quality and efficiency gurus who say we can have higher quality for lower cost. But I don't think so. I've spend enough time talking to patients and clinicians at the forefront of change -- from Annapolis to Akron to Anchorage -- to believe that there is a better way. A way that will bring us quality and efficiency as well as justice and responsibility and compassion. If we can stop shouting long enough to get there.
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U.S. HEALTH*CARE~ CURRENTLY ONLY GREAT FACADE 4 MILLIONS IN USA
~OUR U.S.CONGRESS AT LEAST DOES NOT DISCRIMINATE...THEY AFFORD POORER AMERICANS THE SAME EMERGENCY ONLY HEALTH*CARE THAT ILLEGAL ALIENS RECEIVE~
AMERICA~LOVE IT OR LEAVE IT~ 45,000 DEAD POOR AMERICANS LEAVE U.S. EVERY*YEAR DUE TO 3rd WORLD HEALTH CONDITIONS ??
** POLITICS IN AMERICA IS VERY SIMPLE TO UNDERSTAND WHEN OUR MIDDLE~CLASS & WORKING POOR CITIZENS ARE ALL BEING FORCED 2 ALLOW BIG $$$ TO CONTROL THE PEOPLES HALLS OF THE U.S.CONGRESS..
~ SADLY, OUR VERY OWN AMERICAN HEALTH*CARE SATANIC VERSES HAS KEPT 45 MILLION POOR AMERICANS IN 3rd WORLD HEALTH CONDITIONS ~
DON'T WORRY BE HAPPY ~ THE WORLDS SELECT BILLIONAIRES AND THEIR FRONT CORPORATIONS WILL ALL GET ON BOARD THE NEW HEALTH~TRAIN OF $$$...**ADDING 45 MILLION MORE AMERICAN CITIZENS TO THE CURRENT GIVEN PROFIT MARGINS + WITH A FUTURE AMNESTY PROGRAM
(6 months) AFTER NEXT U.S.PRESIDENTIAL ELECTION = $$$$$$$$$.........
WEALTH~CARE FOR ALL THE HEAVILY INVESTED INTERNATIONAL AND AMERICAN BILLIONAIRES IN THE CURRENT U.S.HEALTH FOR THE WEALTHY ONLY SYSTEM WILL NOT END ANYTIME SOON... IT WILL ONLY BE RE~ARRANGED TO MAKE SURE ALL THESE MEGA CAPITALISTS PROSPER IN JUST ANOTHER FASHION .
THE FINE ART OF DENYING 45 MILLION AMERICANS HEALTH~CARE IN OUR JUDEO~CHRISTIAN NATION IS NOT RACIST AT ALL... IT'S JUST OUR BEHIND THE SCENE WEALTHY ELITE CITIZENS USING THEIR TREMENDOUS WEALTH TO DIRECTLY INFLUENCE OUR U.S. CONGRESSIONAL REPRESENTATIVES IN KEEPING ALL THE little poor folk down *
AMERICAN RELIGIOUS LEADERS ALL ACROSS THE USA HAVE ALWAYS BEEN ABLE TO COUNT ON THEIR RELIGIOUS FLOCK TO CONTRIBUTE(TITHE)THEIR HARD EARNED MONIES TO THEIR MINISTRIES EVERY WEEK. THE MAJORITY OF AMERICANS ATTENDING RELIGIOUS SERVICES IN THE U.S. ARE MIDDLE~CLASS AND WORKING POOR CITIZENS WHO NOW DESPERATELY NEED THE HELP AND SUPPORT FROM THESE SAME U.S.RELIGIOUS LEADERS IN LOBBYING THE U.S.CONGRESS TO PROVIDE PROPER HEALTH~CARE FOR ALL POORER AMERICANS.
***THERE ARE CURRENTLY AN ESTIMASTED 45 MILLION MEN WOMAN AND CHILDREN WITHOUT HEALTH~CARE IN THE WEALTHIEST COUNTRY IN THE WORLD????
SILENT AMERICAN RELIGIOUS LEADERS WHO ALL HAVE HEALTH~CARE FOR THEMSELVES AND THEIR FAMILIES IS MUCH MORE FRIGHTENING THEN THE POSSIBLE DENIAL OF A FUTURE HEALTH~CARE PLAN FOR ALL...
**45,OOO AMERICANS DIE EACH YEAR IN THE WEALTHIEST COUNTRY IN THE WORLD DIRECTLY RELATED TO THEIR LACK OF PROPER HEALTH*CARE.
LAWYERS FOR POOR AMERICANS
(424-247-2013)
DON'T ASK DON'T TELL HEALTH*CARE CRIMES AGAINST HUMANITY IN USA
** SATANS WARRIORS IN OUR U.S.CONGRESS ARE PLAYING THE DEVILS ADVOCATE WITH 45 million POORER AMERICANS HEALTH & WELL BEING **
~ SADLY CERTAIN AMERICAN MILITARY SUPPORTERS IN OUR U.S. CONGRESS HAVE NOW BEEN BOUGHT OUT TO ABANDON THE HEALTH & WELFARE OF POORER MILITARY PARENTS AND SIBLINGS OF OUR ACTIVE DUTY WORLD~WIDE ENLISTED SOLDIERS….
~ A VOTE FOR AMERICAN HEALTH*CARE 4 OUR AMERICAN MIDDLE CLASS AND WORKING POOR CITIZENS,IS ALSO A CLEAR VOTE FOR OUR POORER AMERICAN MILITARY FAMILIES WHO OFFER UP THEIR CHILDREN TO SERVE IN OUR U.S. MILITARY FORCES WORLD~WIDE ~
PRESIDENT OBAMA ~ THE AMERICAN PEOPLE AND OUR ACTIVE DUTY U.S. MILITARY FAMILIES FROM POOR FAMILIES BACK HOME DESERVE TO BE ENLIGHTENED AND INFORMED ABOUT THE SPECIFIC FAMILY NAMES OF ALL THESE NATIONAL & INTERNATIONAL BEHIND THE SCENE BILLIONAIRE HEALTH*CARE INSURANCE COMPANIES(MAJORITY SHAREHOLDER INVESTORS) WHO ARE ATTEMPTING TO CONTROL THEIR FUTURE PROFITS OVER THE HORROR OF KNOWING THAT 45,000 POORER AMERICANS DYING EVERY YEAR DUE TO THE LACK OF PROPER HEALTH*CARE…
IT IS NOW VERY OBVIOUS TO MOST AMERICANS THAT CERTAIN U.S.CONGRESSIONAL LEADERS OF THE FREE WORLD HAVE ALREADY MADE UP THEIR MINDS TO SELL OUT OUR 45 MILLION MIDDLE CLASS AND WORKING POOR AMERICANS… 4 RE~ELECTION MONIES…
~ AND SO, MY FELLOW POOR AMERICAN SOLDIERS:ASK NOT WHAT YOUR COUNTRIES HEALTH*CARE INSURANCE COMPANIES CAN DO FOR YOU- ASK WHAT YOU CAN DO FOR YOUR COUNTRIES HEALTH*CARE INSURANCE COMPANIES ~
** OUR BRAVE AMERICAN ACTIVE DUTY U.S. MILITARY AROUND THE WORLD WHO ARE RISKING AND LOSING THEIR LIVES FOR ALL OF USA ALSO HAVE POORER PARENTS AND SIBLINGS BACK HOME WHO ARE DYING WITHOUT HEALTH*CARE**
*PRESIDENT OBAMA ~ PLEASE MAKE A SPECIAL POINT OF ASSURING OUR AMERICAN MILITARY WORLD-WIDE THAT YOU WILL FIGHT FOR THEIR LOVED ONES HEALTH*CARE BACK HOME ALSO!!!
~ PRESIDENT OBAMA AND U.S. SENATOR OLYMPIA SNOWE OF MAINE BOTH KNOW THAT ANY FUTURE HEALTH*CARE PLAN FOR OUR NEW AMERICA NEEDS TO ALSO ENCOMPASS ALL FAMILY MEMBERS(PARENTS & SIBLINGS) OF ACTIVE DUTY MILITARY MEMBERS…ANYTHING LESS WOULD BE UN*AMERICAN ~
**JUST MAYBE AMERICA NEEDS A FEW MORE REVOLVING DOORS IN OUR U.S. CONGRESS **
OUR COUNTRY COULD REALLY USE MANY MORE SINCERE AMERICANS LIKE THIS SPECIAL U.S.SENATOR OLYMPIA SNOWE FROM MAINE WHO CONSIDERS THIS COUNTRIES 45 MILLION POOR AMERICAN MEN WOMEN AND CHILDREN WITHOUT PROPER HEALTH CARE LIKE HER OWN FAMILY AHEAD OF HER ELECTED POLITICAL FAMILY **
45 MILLION POORER AMERICANS HAVE OBVIOUSLY BEEN TOUCHED BY AN ANGEL WITH THE PEOPLES U.S. SENATOR SNOWE OF MAINE.
LAWYERS FOR POOR AMERICANS THANKS THIS SPECIAL WOMEN FROM THE CARING STATE OF MAINE FOR SHOWING THE REST OF AMERICA THAT GODS VILLAGE OF ANGELICA BEINGS CAN EVEN BE HERE WITH US EVERY~DAY IN THE FLESH.
——————————————————————————————————————————————–
~ OUR U.S.CONGRESS AT LEAST DOES NOT DISCRIMINATE…THEY AFFORD POORER AMERICANS THE SAME EMERGENCY ONLY HEALTH*CARE THAT ILLEGAL ALIENS RECEIVE ~
AMERICA~LOVE IT OR LEAVE IT~ 45,000 DEAD POOR AMERICANS LEAVE U.S. EVERY*YEAR DUE TO 3rd WORLD HEALTH CONDITIONS ??
** POLITICS IN AMERICA IS VERY SIMPLE TO UNDERSTAND WHEN OUR MIDDLE~CLASS & WORKING POOR CITIZENS ARE ALL BEING FORCED 2 ALLOW BIG $$$ TO CONTROL THE PEOPLES HALLS OF THE U.S.CONGRESS..
~ SADLY,OUR VERY OWN AMERICAN HEALTH*CARE SATANIC VERSES HAS KEPT 45 MILLION POOR AMERICANS IN 3rd WORLD HEALTH CONDITIONS~
DON’T WORRY BE HAPPY ~ THE WORLDS SELECT BILLIONAIRES AND THEIR FRONT CORPORATIONS WILL ALL GET ON BOARD THE NEW HEALTH~TRAIN OF $$$…**ADDING 45 MILLION MORE AMERICAN CITIZENS TO THE CURRENT GIVEN PROFIT MARGINS + WITH A FUTURE AMNESTY PROGRAM (6 months) AFTER NEXT U.S.PRESIDENTIAL ELECTION = $$$$$$$$$………
WEALTH~CARE FOR ALL THE HEAVILY INVESTED INTERNATIONAL AND AMERICAN BILLIONAIRES IN THE CURRENT U.S.HEALTH FOR THE WEALTHY ONLY SYSTEM WILL NOT END ANYTIME SOON… IT WILL ONLY BE RE~ARRANGED TO MAKE SURE ALL THESE MEGA CAPITALISTS PROSPER IN JUST ANOTHER FASHION .
THE FINE ART OF DENYING 45 MILLION AMERICANS HEALTH~CARE IN OUR JUDEO~CHRISTIAN NATION IS NOT RACIST AT ALL… IT’S JUST OUR BEHIND THE SCENE WEALTHY ELITE CITIZENS USING THEIR TREMENDOUS WEALTH TO DIRECTLY INFLUENCE OUR U.S. CONGRESSIONAL REPRESENTATIVES IN KEEPING ALL THE little poor folk down *
AMERICAN RELIGIOUS LEADERS ALL ACROSS THE USA HAVE ALWAYS BEEN ABLE TO COUNT ON THEIR RELIGIOUS FLOCK TO CONTRIBUTE(TITHE)THEIR HARD EARNED MONIES TO THEIR MINISTRIES EVERY WEEK. THE MAJORITY OF AMERICANS ATTENDING RELIGIOUS SERVICES IN THE U.S. ARE MIDDLE~CLASS AND WORKING POOR CITIZENS WHO NOW DESPERATELY NEED THE HELP AND SUPPORT FROM THESE SAME U.S.RELIGIOUS LEADERS IN LOBBYING THE U.S.CONGRESS TO PROVIDE PROPER HEALTH~CARE FOR ALL POORER AMERICANS.
***THERE ARE CURRENTLY AN ESTIMASTED 45 MILLION MEN WOMAN AND CHILDREN WITHOUT HEALTH~CARE IN THE WEALTHIEST COUNTRY IN THE WORLD????
SILENT AMERICAN RELIGIOUS LEADERS WHO ALL HAVE HEALTH~CARE FOR THEMSELVES AND THEIR FAMILIES IS MUCH MORE FRIGHTENING THEN THE POSSIBLE DENIAL OF A FUTURE HEALTH~CARE PLAN FOR ALL…
**45,OOO AMERICANS DIE EACH YEAR IN THE WEALTHIEST COUNTRY IN THE WORLD DIRECTLY RELATED TO THEIR LACK OF PROPER HEALTH*CARE.
LAWYERS FOR POOR AMERICANS IS A WWW VOLUNTEER LOBBY FOUND WITH ANY SEARCH ENGINE. (424-247-2013)