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Sometimes Change Hurts: The Politics of Policy

Posted By Ben Miller, Tuesday, November 10, 2009
Updated: Wednesday, June 1, 2011

I was in Kansas City this past week for a conference, and realized a travesty was occurring on Saturday, which I had no control over: My hotel did not carry CSPAN.

For those of you non-policy wonks, CSPAN stands for Cable-Satellite Public Affairs Network. What was an out of town guy to do? The only thing that made sense to me was to begin walking and convince a bartender to change the channel from World Series of Poker to CSPAN. To make a laborious story short, I eventually ended up at a swanky seafood and steak house in the new Power and Light District in downtown Kansas City. The bartender graciously agreed to change the channel off the horse races to allow me a few minutes with the glorious debate unfolding before my eyes. They even turned up the sound for me so I could hear the constant objections and rude interruptions by some of our elected officials. I was in heaven. This was politics at its finest. Positioning, grandstanding and strategizing - all for a vote which would not come for many hours later. I could tell you more about my experience at this restaurant, including the cardiac nurse who served me my drink, the uninsured bartender who was confused on how healthcare was paid for, the hostess who told me the story of her being denied coverage, but I will reserve those stories for another day (you could also check out one of my favorite books on the topic: Cohn's Sick).

Policy, as one mentor described to me, is movement in a direction. What we saw on Saturday (if you were able to stay awake) was historical movement. This was the first step in a significant policy that could possible change healthcare for years to come. Was this bill perfect? Absolutely not. Was this bill a step in a direction? Absolutely! Speaker of the House Nancy Pelosi had to make concessions to allow this bill to come to the floor for a vote that would pass. Interestingly, the House has done their job so it is the Senate now standing in the way for healthcare reform to take place. In some ways, this was politics as usual, in other ways, the introduction and passage of the bill was not. Therefore, we have movement in a direction - we have the beginnings of a new health policy. (And how cool was it that Dingell sounded the initial gavel? If you don't know the historical significance of this, read here).

Change is usually not easy; however, we make changes daily whether or not we recognize them. Imagine doing something for so long that you don't know that what you are doing may have a different way to be done. Maybe it's pronouncing a word or singing lyrics incorrectly. To you, this is all you know ergo correct, but maybe it's not. Someone corrects your language or you hear someone singing the correct lyrics and boom, you are made aware of a discrepancy in what you have always known as accurate. Sadly, this has not been true for healthcare. The current healthcare system has been working ineffectively for years, and knowingly doing so, but despite being made aware of the inaccuracy of this approach, nothing has been done. While it may not hurt too much to change the way you say a word or sing a song accurately, it may hurt to change an entire system, which is responsible for taking care of what is often most precious to us, our health.

Tying this all together, there remains an opportunity to continue the inertia behind healthcare while still advocating for change. Collaborative care, as a field, is not directly addressed in the House bill. Does this mean that we cannot still push for policies on better care through integration and defragmentation? No, it means that we still have our work cut out for us. Stay involved in the national policy discussion, but act locally. Talk about this with your friends, family and colleagues. Inform the misinformed. Call and email your representatives to tell them what you think about healthcare. Use your voice. Change may be hard and occasionally hurt, but it begins with the recognition that there needs to be a change. There is no better place this is true than within healthcare.

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Randall Reitz says...
Posted Friday, July 8, 2011
Ben, this is a good reminder. I was hoping for healthcare reform to pass in some form before the August recess (it seems like so long ago now), and now we're hearing that the senate might not even debate the bill until after the holiday recess.



As a political moderate, I find myself doing a lot of 1 of 2 things:

1) Challenging people's perspectives that I think are poorly informed.

2) And conversely, challenging my more liberal colleagues to act incrementally and not let the perfect be the enemy of the good.

In either situation, it is usually easy to tell whose talking points a person is spouting--MSNBC's or Fox News'.



Being politically unconnected, I do wonder about how to bring collaborative care into the conversation. It seems like one of the most effective approaches is to advocate through other organizations that are connected, like your work with the Patient-Centered Primary Care Collaborative.
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