This blog has argued that healthcare reform is economically, societally, and medically necessary. There is no lack of ideas, idealism, or compassion to move reform forward. What is lacking is power — hard political power and soft civic power. Political power is stymied by targeted voter disenfranchisement and by distorted campaign finance. How to fix these with legal remedies is the subject of this Part 1 post.
Civic power is weakened by our American house divided against itself – four ways, according the writer George Packer. Societal divisions feed the political divisions. Finger-pointing won’t help. Americans have no choice but to do the hard work of summoning courage, humility, and effort to rekindle our aspirations to unity, equity, and thriving. Part 2 post will claim that only after needed political reform and civic revival can we get healthcare reform that cares for all, constrains relentless spending hikes, and produces quality, value, and efficiency.
Fixing U.S. Healthcare has argued that healthcare reform is economically desirable, societally compelling, and medically indispensable. So, why hasn’t it moved forward? Just pointing our finger to blame others hasn’t worked — there are three other fingers pointing back at us all. Let’s explain . . .
Previously this blog has claimed that reform has stalled not for lack of ideas about reform – there are many. This blog has also claimed we do need more Yankee idealism and more empathy to motivate reform. But their lack, likewise, does not explain the inaction.
Imbalance of Power
It comes down to power, hard power to set the political rules and soft power to influence social norms. To use a football analogy, healthcare reform is not mainly about the ball itself but rather about the field, the rules of play, and the players.
In other words, this blog does not single out one lone culprit. Nor does it blame a “grand conspiracy” of many culprits. Instead, this blog suggests that there is a “force field” of powers either impelling reform or resisting it. Some elements identified by this blog are quite obvious – health systems, their lobbyists, pharma, professional associations on one side, and academics and organized advocacy groups on the other. Other elements are more subtle, some impelling and some resisting reform – corporations, small business, healthcare workers, public opinion.
On top of these stakeholder roles every individual American is also an actual-or-potential patient. Each individual patient may be frugal, or may demand expensive care for themselves. And we may either seek to include others who lack care, or may condone their exclusion under the principle of “individual responsibility.”
This blog sees an imbalance of power between individual actual-or-potential patients – the People – and the powerful, well-funded healthcare-industrial complex. This means that the powerful healthcare corporations themselves are not the bogeyman standing in the way of progress. They seek their own profits and (non-profit) “margins,” as they should. And they do so within the system framework in which they operate, as they must.
Likewise, the People are not the bogeyman, seeking to suck the lifeblood from corporations using government authority to then redistribute care to “takers” of healthcare.
Instead, it is the imbalance between healthcare-industrial complex and the People — too much power for healthcare and not enough countervailing power for the People.
This blog sees a striking irony here, since theoretically health interests should converge. Business needs healthy workers. The health sector needs consumers who cooperate and pay. Citizens need fellow citizens who behave responsibly. Patients need accessible, affordable, and good-quality healthcare services.
So, then, what are the imbalances that have thrown healthcare off kilter? Why does 12 percent of the adult citizenry lack insurance and access to care? Why are workers getting less in their paychecks as employers pay more and more for health benefits? Why do Americans put up with high-cost-low-benefit services and fragmented, administratively inefficient care?
This blog sees two imbalances in both hard power and soft power – political and civic.
Imbalance of Political Power
The balance of political power is distorted by election procedures and campaign finance rules that empower money over voters in many respects.
Scholars of the American Academy of Arts and Sciences (AAAS) wrote of these imbalances in their 2020 report, Our Common Purpose. They offered an array of actionable recommendations to achieve these imperatives. Here are a few examples, offered for discussion but not necessarily endorsement:
- Provide independent citizen redistricting commissions with fairness criteria, and change elections to non-winner-take-all models, such as ranked-choice formats.
- Amend the Constitution to authorize the regulation of election contributions and spending to eliminate undue influence of money in our political system; this amendment would override the 1976 Buckley, 1978 Bellotti, and 2010 Citizens United rulings that essentially allow unlimited corporate finance contributions.
- Pass strong campaign finance disclosure laws to end “dark money”
- Give people ample choices about where and when they vote, for example voting centers, early voting, mail-in voting.
- Enact a voting requirement analogous to jury duty, with a small fine for unexcused non-participation and allowance of votes for “none of the above.”
Imbalance of Civic Power
The imbalance of hard political power arguably reflects an underlying imbalance of civic power that stoke division and inhibit social solidarity in present-day America. To address this current social ferment, AAAS endorses the objectives of
- Dramatically expanding civic bridging capacity, to promote “dialogue across differences”
- Building civic information architecture – especially social media mechanisms — that promotes our national common purpose
- Inspiring a culture of commitment of American Constitutional democracy and one another
AAAS scholars offer specific recommendations to achieve these objectives, as well. This blog does not endorse all, but presents a few examples here to stir reflection and dialogue:
- Activate funders to invest in “civic one million” leaders to catalyze local civic bridge-building and citizen engagement
- Reimagine social media to: define its civic obligation, invest in public functions that have been displaced by social media (for example investigative journalism and public social media platforms), create a “public interest” mandate for for-profit platforms, re-regulate social media architecture (interoperability, portability, etc.), design metrics to monitor adherence, and fund research social media’s influence on democratic engagement
- Establish mandatory one-year of national service, including military and AmeriCorps but also local government, news organizations, and non-profit organizations.
- Promote a “Telling Our Story” initiatives to celebrate our upcoming 250th Independence anniversary, aimed at allowing “participants along the political spectrum to explore both their feelings about and hope for this country.”
Let’s Get Real
Is that it? Just get together and all sing “kumbaya”?
The next post Part 2 will dive deeper into why it will not be so easy.
Title: Pointing Finger (detail, Archduke Ferdinand Karl, 1762)
By: Jean-Étienne Liotard, Public domain, via Wikimedia Commons