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Truth and Trust in 2021.

Posted on | December 29, 2020 | 2 Comments

Mike Magee

Exactly three years ago, veteran Health Policy expert, James A. Morone, Ph.D., made an interesting argument for single payer health care in the NEJM. In proposing a sweeping change that would directly address “the American patchwork”, assert “the norms of communal decency”, promote planning and efficiency, and empower “a righteous band of reformers, deeply committed to a cause, pushing against all odds”, he did not sidestep higher taxes on the rich.

Rather he sold into them, presenting high taxes on the rich in return for universal health coverage as “on a short list of available policies designed to push back on inequality.”

His argument boiled down to the fact that a central element of the national crisis we called “Trump” was populist anger grounded in remarkable income inequality. In roughly a half-century, our separation between rich and poor which used to mirror France and Japan, now aligns with Mexico and Brazil.

Three years later, with Covid ravaging us unabated, we’re a mess, and our citizens are pretty fed up. And why shouldn’t they be? Our top 1% controls roughly 40% of all wealth, while the bottom 90% manages a paltry 23%. If you’re a white family in America, you were born lucky. On average, your family is about 10 times as wealthy as your black family counterpart.

Back in December of 2017, Morone reminded us that major policy changes can, and have, flipped on a dime in the past. As he wrote then, “Disruptive populism ended past American gilded ages, and it shows signs of challenging the current one.” With better health delivery, and more equality and social justice, we might also redirect the course of American politics and American politicians.

In the same issue of NEJM,  Henry J. Aaron, Ph.D., explored a different road to reform, raising legitimate concerns about the unintended consequences of disrupting existing insurance holders, and arguing for a more cautious incremental approach including extending availability of Medicare and Medicaid to others, and shoring up ACA exchanges. He wondered then how far and how fast Americans were willing to go?

That same week, New York Times columnist, Thomas Friedman, presciently shared his view. He didn’t pull punches when he accused Trump of intentionally undermining the two critical pillars of American society, truth and trust. And here we are today.

Interestingly, in the careful analysis of these two health policy experts above, both identified an embattled and epic American struggle over how to topple the health care status-quo, a Medical-Industrial Complex controlled and directed by members of the 1%, and a debate that currently hangs on whether we – the citizens – are able to discern fact from fiction.

The key question for health reform and for the future of America: Do we trust a government “of, by, and for the people” to assure that each of its citizens has the right to “life, liberty, and the pursuit of happiness?”

Trump is all but gone -rejected, dejected, marginalized and soon-to-be ignored. It is now on us. If a majority of Americans can move to “yes” on truth and trust, we will find a way to embrace each other equally through health reform. And the quality and durability of that embrace will be determined by these Code Blue principles:

1. Universality: Comprehensive health coverage is a right of citizenship.

2. Public Administration: Administration of basic health coverage is organized in the most cost-efficient manner possible with central oversight by the government. 

3. Local Control of Delivery: The actual delivery of services is provided by health professionals and hospitals at the local and state levels.

4. National Health Planning and Coordination is a Priority:  Creating healthy populations is a high priority on the federal and state levels. (Covid disaster – never again!)

5. Transparency: Providers submit bills. Government ensures payment of bills. Patients focus on wellness or recovery.

2021 is the year to do right by each other and take care of each other!

Comments

2 Responses to “Truth and Trust in 2021.”

  1. Lawrence Williams
    December 30th, 2020 @ 10:02 am

    The Code Blue principles you recite are valid and if implemented could certainly go a long way to correct many of the inequities in the current “American patchwork” system of health care delivery. There are however still some very difficult barriers to achieving real health care equality. One you have identified and that is the ability of the American public to “discern fact from fiction”. More than 70,000,000 Americans voted for Donald Trump, the biggest, most openly pathological liar in modern history to occupy the Oval Office. And each one of these votes calls into question the voter’s ability to or their concern for telling truth from lies. And notably the presentation of mountains of factual data to these Trump supporters seems to make no difference as they knowingly choose to ignore the facts and believe Trump’s lies. And, even if all of these issues are addressed there is one more huge road block to making the necessary changes and that is the arcane rules of the United States Senate which in effect put the majority leader in a position to single-handedly control what legislation is allowed to come to the floor for the Senate to consider. This essentially makes the majority leader a monarch controlling what the duly elected senators of every state, regardless of political party, get to debate and vote yea or nay. There is much work to be done both within and without the actual borders of our health care system.

  2. Mike Magee
    December 30th, 2020 @ 11:36 am

    I’ve struggled with this 70 million Trump voter issue in my mind. On the surface, it feels like a broad recrimination of the ethics and intelligence of nearly half of American voters. Even if you grant targeted voters against abortion, or for state’s rights, or concerned about budget deficits, this requires that we accept a remarkable reliance on situational ethics: that you could accept evil, degeneracy, selfishness, and cruelty in a clearly unstable leader if you were able to get what you wanted in the bargain. While there may be elements of truth in that, I think it’s too simple an explanation. There are other contributors. We are a consumer society (aka greedy). We are a individualistic society (aka no tradition of solidarity). We are a gullible society (aka naive). We are an entertainment society (aka easily distractible). We are a youth obsessed society (aka immature and disrespectful of our elders). We are Americans (aka vulnerable to someone exactly of the size and dimensions and character of Trump). The good news is – we are other things as well – innovative, creative, energetic, immigrants, hopeful, and loving (sometimes). This time around, good conquered evil – barely. Now we must demonstrate that we know how to use the power to move the needle in favor of our better selves. How do we make America healthy – in body, mind, and spirit? That is the question.

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