Monday, August 17, 2009

Healthcare: More Heat Than Light?

Our national healthcare debate, such as it is, ought to be seriously continued every year until we develop a system that serves us much better than the current mess.
If this sounds like I doubt that a single, comprehensive program can be adopted at any one time, your interpretation is correct.
The reason is that politics is simply the art of the possible, and Congress lacks the unity, courage and visionary insights to do this job right.
Of course, President Obama and his administration don't get off the hook either, but since when has an operating manual come with our highest office?

Obama's biggest problem is that he is trying to be too inclusive and flexible under the circumstances.
That is being perceived as either weakness or waffling by both sides, for different and varying reasons.
That is a no-man's land that is unlikely to yield any productive result, save maybe one; agreement that certain aspects of healthcare do need to be changed.
Once that consensus is reached, the job becomes a little simpler, but also longer term in nature.
Simpler, because sufficient votes can likely be garnered for incremental changes that both parties can support.
Things like providing and extending at least catastrophic medical coverage for all citizens.
Or maybe even some tort reform.

Yesterday's Crosscut article by Ted Van Dyk provides a useful perspective on this general strategy.

The longer term nature of debating the healthcare issue, means that Congress and the Administration must find a way to commit to continuing good faith discussions well into the foreseeable future.
Why not bring this up every year as part of a national debate that also ties into whatever economic conditions exist, and our annual budgetary approval process?
That way, it would be harder to dismiss making controversial decisions based upon 'the time not being right'.
When is the time ever right? Especially for those who perpetually resist change?

What I'm talking about is a form of 'phased implementation', where the cumulative impact of incremental changes can fit into and become part of an evolving national healthcare strategy that leads toward a sensible system that doesn't create too many short term dislocations -either real or imaginary.
I have learned that taking heat one time is preferable to taking it multiple times, but that mainly applies to a single issue -think Lake Whatcom for example.
But, the basic weakness with trying to solve a big problem at one stroke is that it simply doesn't work very often -even if sufficient 'votes' can be garnered!
There are always new twists and turns, things that weren't anticipated, new elected officials and fiscal realities.
Think it's easy? Think again.

Maybe the best example of what I'm trying to illustrate is our own Constitution.
As good a document as that is, with its high-minded principles and visionary wisdom, it was adopted by a very slim margin and based upon the best compromise available at the time.
Since then, even our sacrosanct Constitution has been changed or modified several times by amendment, the Bill of Rights, and possibly by judicial interpretation.
As wise and courageous as our Founders were, they also understood that a democracy needs to adjust to circumstances and changing realities over time.
Just look at some of the issues they failed to adequately address over 200 years ago, like slavery and universal suffrage.
Don't you think the Founders meant for our Constitution to be a 'living document' that allows some very careful adjustment from time to time?
I know I do, and history easily demonstrates it.

Now, back to healthcare.
I believe that ready access to some practical level of healthcare is a basic human right for citizens and residents of this country.
Determining what that level is and implementing a plan to provide it is what is being debated right now.
But, a simple, one-time debate won't likely do the job needed.
That's why addressing this issue every year is necessary, and Congress needs to do the one thing it is least likely to do; discipline itself!
Only after having its collective nose rubbed in healthcare every year will Congress & the Administration - or some future iteration of both - be forced to deal with it meaningfully.
OK, I know that hasn't happened regularly on Medicare or Social Security, but it needs to in the future - without unduly burdening the present 'debate'.

The current 'debate' exemplifies what has become a national embarrassment; the substitution of uninformed and emotionally charged opinion that is exceptionally well-financed, for a fact-based and rational discussion among responsible adults.
And, this debate does need to be conducted respectfully by mature adults -on behalf of children, others and themselves at some point in the future.
Failing that, we'll have to do what we're doing; flailing and flogging individual pieces of the healthcare puzzle, without knowing what the big picture is or needs to become.
That is where broad principles can be helpful in delineating what is truly important and of deservedly lasting value.
You know, kinda like our Founders did when they conceived, debated and adopted our Constitution.

Enough of the verbalizing of things that haven't even been written down or agreed to.
That is a phantom tactic that is built on the quicksand of lies.
We can do better than that.
Much better!
Let's get that message to our elected officials, despite their distractions toward being reelected.
Why did we elect them in the first place?