Health Care Policy Development: We can't just call names

In a voice mail last week, a caller stridently informed me that “This is America.” This individual had read comments in my January 1^st blog, regarding health care. The caller stated: “You know, a federal judge in Florida just declared Obamacare unconstitutional.” Undoubtedly skilled in political philosophy, he then informed me of his overall conclusion: “This is not socialism; it’s not fascism. This is America.”

Although I had publicly presented my views, the caller, in the true spirit of free speech, remained anonymous and blocked Caller ID.

His narrow-minded, strident approach – laughable in some ways, sad in others – should concern us. The content of his view on health care does not disturb me, nor does his ignorance. Rather, it’s the style of attack, and the infectiousness of this style, especially if fueled by ultra-partisan, fear-mongering political commentators – that’s what’s scary, at a time when we need multi-partisan efforts to overcome significant challenges which our communities face.

His ignorance – we can dispose of that quickly. He failed to understand what the judge actually did. The Florida judge ruled unconstitutional the “individual responsibility” provision of the Affordable Care Act, which compelled the purchase of health insurance; the judge went on to state that this provision seemed so integral to the legislation that the entire act would have to fall. Other federal judges earlier ruled the opposite way, but the caller did not indicate how those rulings fit into his “this is America” thesis.

In fairness to the anonymous caller, I have reservations about requiring people to purchase health insurance. I do understand the logic of the requirement. Given market forces, it makes sense to require the purchase of insurance, in order to lower overall insurance costs for everyone. We’re stuck with that situation for as long as we fail to provide universal coverage for all. Nonetheless, as the Florida judge and at least one other judge have decided, mandating the purchase of health insurance might go too far, no matter how good the mandate’s rationale.

Disturbing, however – for those of us devoted to informing and working with the electorate and public officials, to promote wise public policy – is the caller’s immediate descent to the level of mischaracterization and “name calling” to draw attention away from rational debate over the issues: “If Paul supports health care for everyone, he must be a socialist or a fascist. Let’s marginalize his opinions with some distasteful labels and make sure nobody pays attention to Paul.”

I do not espouse a partisan view on health care. Universal health coverage for all Americans can come in Republican, Democrat, liberal, or conservative dress, for all I care. My goal is to optimize the quality of life for all and to do so in a collaborative, multi-partisan way. With respect to health care, that requires finding a means to ensure that all people in this country can go to sleep at night, comforted in knowing that they have the health coverage they need.

Why is this important? Notwithstanding any ethical opinions we might have regarding whether or not people deserve health care, the fact is that, among the developed nations of the world, we do not look as good as we should on health outcomes. Our rates of obesity and overweight exceed those of almost all other developed countries. People live longer elsewhere, e.g., in several European countries. Because of health care? Not necessarily; research evidence provides mixed findings, at least regarding the past. However, in the U.S., our fastest growing populations have the poorest health outcomes (higher mortality rates, higher diabetes rates, higher obesity rates), and they have the lowest rates of access to health insurance and health care. We must pay attention to this.

My response to the caller: I understand “this is America”. I have concern not about the status quo, and maintaining what is America, but rather about the future, and what will be America. To create the future we want in the 21^st century, our debate about issues has to rise above name calling; our progress must include multi-partisan give and take.