My son came home from college one afternoon this past fall and told me about a discussion on universal health coverage that had taken place in his political science class. Politically and philosophically, his classmates range from very conservative to very liberal and include some European students who could most accurately be described as social democrats. The discussion, as these discussions usually are, was a heated one. Should those of us who work hard, have good jobs, eat well and exercise regularly pay to insure the poor or unemployed and those who eat too much, are overweight and smoke/drink to excess? A segment of the class did not think so and argued vehemently that each person should be responsible only for him- or herself. Why should the hard-working and responsible have to subsidize the irresponsible, they argued. In stark contrast, my son said, his Dutch friends sat with their mouths open, listening to the discussion. When it came their time to talk, they said that it was the duty of any civilized society to take care of all of its own. They were shocked that anyone could think otherwise.
I asked my son who won the debate. No one, he replied. There were valid points made by both sides, and it was hard to make a convincing argument for one viewpoint over another. The only consensus that could be reached was that the debate boiled down to a matter of values. In essence, what do you value more: the individual and individual responsibility, or the group and the needs of the community as a whole? Do you get a better society by providing incentives for the individual to succeed or by providing for group needs over the individual?
Obviously, these are arguments that we have all heard many times. It is difficult to say anything new about health care reform, and tackling the topic in a blog — particularly this week when the reform bill will probably reach a vote — is a bit daunting. But my son’s experience struck me in a way that all the rhetoric, the mind-boggling details and the endless debates haven’t. It somehow clarified the fact that at its heart, this is a debate about our values as a society. Not just the obvious ones such as individualism vs. the collective good, but a debate about the deeper values we hold as a people, values of which we are mostly unaware until we come up against an issue such as health care reform.
At the Press Ganey National Client Conference this past fall, in a debate about health care reform between Nancy Kane, DBA, a professor of management at the Harvard School of Public Health, and former House Speaker Newt Gingrich, Kane presented a slide that listed some of the most salient and valued aspects of our national culture — our belief in individual responsibility, our distrust of big government and central planning, our faith in technology, our drive to be the best and our optimism, pragmatism and innovative spirit. She linked those aspects to the health care system that we have now: a system that is first in the world in the care of the individual but leaves many in our country uninsured and underserved; that is expensive and inefficient but looks to the market rather than government for solutions; and that responds quickly to emergencies and acute illnesses but has trouble stepping back to provide for the needs of a dying patient when quality of life rather than conquest of disease is paramount. Gingrich, who upon leaving the House founded the Center for Health Transformation, a health policy think tank, provided examples of successful and innovative programs aimed at providing needed health care services throughout the country. One speaker provided a system-wide view, the other examples of individual inventiveness and hard work.
They both described the same health care system, the one we have now. And as my son’s class further illuminated in their discussion, that system reflects the values upon which our country was built, for better or for worse. Will we be able to amend the best of those values to forge a better system? I’m optimistic. But then again, we are still the only country in the world that hasn’t converted to the metric system, so I also know that we can be stubborn and slow to adopt anyone else’s ideas or values as our own—even when those ideas work well everywhere else.
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