Time for change, progress, reform of health care despite the history of challenges of this scale

It’s impossible not to be deeply troubled by the fear, uncertainty and doubt rolling across our country about health care reform. The politics are obviously driven by a lack of belief from opponents in the fundamental structural issue itself. Simply, many of those opposed have health care services, at a decent rate, and are concerned they will be a ‘net loser’ with systems reform. This goes to the core of Machiavelli’s quote that rests on my wall in my legislative office, courtesy of my late mentor Featherstone Reid:

“There is nothing more difficult to take in hand, more perilous to conduct, or more uncertain in its success, than to take the lead in the introduction of a new order of things. For the reformer has enemies in all those who profit by the old order, and only lukewarm defenders in all those who would profit by the new order, this lukewarmness arising partly from fear of their adversaries … and partly from the incredulity of mankind, who do not truly believe in anything new until they have had actual experience of it.”

– Niccolo Machiavelli

Yet there are people and institutions fully engaged in giving it all they have. The fact that Obama has chosen to make this his signature domestic agenda item, the willingness of supporters and opponents to engage in the dialogue with both civility and hostility (everyone’s in the game), the stakeholder positions. All of these and more suggest that if we fail we will lose the opportunity of this crisis at a systems level…meaning, simply, that the cost of failure from a political standpoint would be astronomical.

Yesterday in the mail Wendy received a brochure from the American Medical Association (disclosure: Wendy is an anesthesiologist and member of the Washington State Chapter of the AMA). I was simply amazed at the content. It’s titled “What is the real story on health care system reform?” The brochure proceeds to map out their position in strong favor of meaningful health care reform. The AMA challenges physicians to engage in the process at more than a superficial level and, equally important, actually attempts to educate their constituency about the real deal policy issues and the reasons so many of the provisions in the bill are positive for patient care and physicians.

It’s easy to find opponents to health care reform and it’s easy to stereotype who is on board and who isn’t. We’re not in Washington, D.C. and we all know we can’t pretend to know the inside of who is saying what in the lobby halls of Congress. The insider game often looks differently than the outside. But whatever they are saying on the inside, this AMA brochure sent to docs was pushing, prodding and educating physicians to recognize the good in the health care reform initiative and working to engage their constituency in supporting the effort.

As a central piece of this challenge, I reiterate my call for a ground war not only for health care reform in terms of governance, payments, insurance and options…but on building ownership of our own health and increasing personal responsibility. Obesity is the great issue of our time in terms of quality outcomes.

It’s easy to stereotype who is pro and who is con….who is fighting inside and who outside…progressives against reactionaries….business against labor…community organizers against corporate greed….all of these ascribe the worst to people and suggest that we’re all Machiavellian in our political decisions.

Perhaps. But I believe, heart and soul, that many people know on a deep level that we we’re paying more and getting less than most other countries in the world. That we’re not investing in prevention and wellness compared to disease cure models of care. That we are spending too much money in hospital rooms instead of community clinics. That we’re not valuing health care for children the way we must.

Is health care a right? Yes, but it is not a right without responsibility.

We can be so much more, we can do so much better, we can make this work.

Yes we can!