Social Solidarity is Key to Meaningful Health Reform

On HealthBeat, I have talked about social solidarity as the key to meaningful health care reform.

In his victory speech, President-elect Obama sounded that theme repeatedly, reminding his audience that he had been elected “by young and old, rich and poor, Democrat and Republican, black, white, Hispanic, Asian, Native American, gay, straight, disabled and not disabled—Americans who sent a message to the world that we have never been just a collection of individuals…”

In the recent past, some progressives have warned that liberals made a mistake when they reached out to minorities, new immigrants, and gays, “ignoring” the mainstream middle class. But in fact, “mainstream” America is no longer one recognizable culture. It is fast becoming a “magnificent mosaic,” the phrase Mario Cuomo used when he ran to become mayor of New York City in 1977.

Barack Obama won, not because he managed to win over the white middle-class, or the white working class, but because he managed to put together a coalition from so many groups—including white voters.  Many thanks to Ezra Klein for breaking down the vote: 31.82 percent of voters who chose Obama were white, just as 31.57 percent of the voters who stood for John Kerry in 2004 were white.  But Obama won. What was the difference?

“Obama increased the share of the black vote from 11 percent to 13 percent,” Klein explains, “increased the share of the ‘other’ vote from 2 percent to 3 percent, grew his share of the black vote by seven percentage points, grew his share of the Hispanic vote by 13 (!) percentage points, grew his share of the Asian vote by five percentage points, and grew his share of the ‘other’ vote by 11 percentage points. Consequently, while just 16.12 percent of 2004 voters” who chose Kerry “were non-white, fully 20.15 percent of 2008 voters” who plumped for Obama were non-white. “That 4.03 percentage point increase was the difference maker.”

Drawing from such a diverse population, President-elect Obama is now asking us to come together, and to think about our country, not as individuals, but collectively: “Let us summon a new spirit of patriotism; of service and responsibility where each of us resolves to pitch in and work harder and look after not only ourselves, but each other…”

He is asking that we focus, not on ourselves, our families, or even our favorite causes, but rather on the challenges that we must face as a nation: “two wars, a planet in peril, the worst financial crisis in a century. Even as we stand here tonight, we know there are brave Americans waking up in the deserts of Iraq and the mountains of Afghanistan to risk their lives for us. There are mothers and fathers who will lie awake after their children fall asleep and wonder how they’ll make the mortgage, or pay their doctor’s bills, or save enough for college. There is new energy to harness and new jobs to be created; new schools to build and threats to meet and alliances to repair.”

But where, on that list, is healthcare?

It’s not there.  Here, I will say, as I have said before, that collectively, we have other priorities that may have to come first. Some months ago, a solider told me about a friend, also in the army, who volunteered to learn how to help Iraqi soldiers detect buried land-mines. His first day of training, he saw his instructor vaporize, before his eyes. This solider then had to stay in Iraq for another six months, disabling land-mines, despite the fact that his hands shook.

He is a priority. The poor, who are more likely to die prematurely, whether or not they have access to healthcare– they are a priority. The soon-to-be-unemployed, they are a priority. Reforming healthcare will not create jobs. Building schools and exploring new forms of energy will. (While we need more primary care doctors and nurses, very, very few people are interested in filling these jobs. Rational health care reform would lead us to close some hospitals, eliminating redundancies in the system, while opening community health centers. Net, net we would lose jobs.)

It is worth remembering that, even before the economic melt-down, Obama talked about trying to provide health care coverage for all Americans only “by the end of my first term.” He never planned to rush ahead, understanding that if health care reform was to be done in a way that contains costs and lifts quality, it would take time and serious seed money. Keep in mind: one reason we elected Obama is because he projects a sense of calm and maturity. He moves thoughtfully and deliberately.

I, of course, continue to think that healthcare reform—and particularly Medicare reform, Medicaid reform and expanding SCHIP—are extremely important.  Moreover, I believe that there are steps we can take in 2009 to contain health care inflation and pave the way for national health reform.

As I wrote earlier this week, I also agree with Congressional Budget Director Peter Orszag: spiraling health care costs are a major force behind the nation’s fiscal crisis. So the economic crisis cannot be divorced from our healthcare crisis.

But Orszag recognizes that healthcare may have to wait: “Many observers have noted that addressing the problems in financial markets and the risks to the economy may displace health care reform on the policy agenda — and that may well be the case for some period of time.”  Over time, he argues, “it will be crucial to address the nation’s looming fiscal gap — which is driven primarily by rising health care costs — as the economy eventually recovers from this current downturn.

Some see healthcare reform as a political opportunity, a chance to “score” early in Obama’s administration. I would argue that what we euphemistically call our health care “system” needs deeps structural reform. This is an enormous task that will require more than one piece of legislation as we move toward evidence-based, patient-centered medicine.

We should do our best to address the needs of children (SCHIP), and the poorest among us (Medicaid patients) now. But simply pouring billions into the black hole of a broken, greedy, and wasteful system that puts the needs of those who profit from it first would be a terrible mistake.

I also think that we each need to take our blinkers off and, rather than focusing on our favorite issue, see the country whole.  As a nation, we face a world of trouble, more trouble than we have seen since 1930. The Bush administration dug a very deep hole.

Wisely, Obama does not pretend that he can dig us out in one year—or even in four years. “The road ahead will be long. Our climb will be steep. We may not get there in one year or even one term,” he acknowledged, “but America – I have never been more hopeful than I am tonight that we will get there.”

Obama’s achievement, thus far, has been to draw out Americans who had never voted before—bringing them together with citizens who, in the past, were not at all certain they wanted all of their neighbors to vote.

This brings me to what we can do to help President Obama. We can join together behind him—and let him lead. We gave him a solid majority; now let him set priorities. If I have one wish today it is that the pundits will take a vow of silence. I don’t care to know who Chris Matthews thinks should become Secretary of State. Or what Fox News thinks that Obama should do next. This too-long election has left me weary of all of those who would second-guess and criticize each and every move that a politician makes.

I am not suggesting that we shouldn’t disagree with this president. But I am suggesting that if we can all make an effort to look above and beyond the speck of  self—and try to understand where the president  is leading us and why—it will be much easier for him to move forward. This is a time for leadership and solidarity, not a time for division and self-serving debate.

Maggie Mahar is an award winning journalist and author. A frequent contributor to THCB, her work has appeared in the New York Times, Barron’s and Institutional Investor. She is the author of  “Money-Driven Medicine: The Real Reason Why Healthcare Costs So Much,” an examination of the economic forces driving the health care system. A fellow at the Century Foundation, Maggie is also the author the increasingly influential HealthBeat blog, one of our favorite health care reads, where this piece first appeared.

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5 replies »

  1. > It will be up to Obama to come up with a solution
    > that gets the “social solidarity” running in both
    > directions.
    He can’t. All he can do is make another rule for people to chafe at even as they benefit from it, game it, and break it.

  2. I think Tom hits it pretty close. Gaming the system is America’s favorite pastime, with policians at the top of the list driven by corporations setting the gaming agenda. We won’t get social solidarity without political solidarity first. One of the biggest mistakes this country has made is to legally give corporations the same rights as citizens. Citizens are going to have to accept less affluence, or at least less desire for affluence to get us through this. I’m not sure with this big a hole and America’s usual short-sighted desire for quick fixes, there is enough reserve left for individuals to feel much generosity. We can continue for a while to bail out everyone and every mismanaged corporation, but at some point the money flow will need to stop and we will have to let some companies fail. I for one don’t have an ounce of solidarity for GM and Ford who have gamed the system for decades and now want me to keep them afloat. It will be up to Obama to come up with a solution that gets the “social solidarity” running in both directions.
    Here’s my first citizen social solidarity suggestion: Set a floor price for gas at $4 per gallon with the difference being a tax that is used to fund environmentally sound energy conservation and alternatives (no not corn ethanol). If the price of gas goes above $4 then there will be no added tax. I’ll kick in on that -anyone else? Anyone willing to open up your solidarity wallet, or do we just keep printing money.

  3. I respectfully disagree with the central theme here. We should not wait until Obama is ready to address healthcare reform. Government, by it’s very nature, will never have the focus that real healthcare reform will require. We have given our gov’t too much to do already. We need to organize multi-stakeholder teams right now to attack problems in specific areas of the system. For instance, a team of physicians, payer reps, employers, could be assigned to developing medical/reimbursement policy standards that all payers must utilize. Another team, consisting of mostly physicians and IT professionals, can work on developing an evidence-based decision support system that is accessible from any computer or mobile device.
    I tend to draw a lot of fire (particularly from Peter) when I say this, but no one has the same level of in depth knowledge to fix healthcare that healthcare has. There just needs to be a strong mandate to bring everyone together. I know it can be done because it’s already happening to a small degree. Geisinger Health System is doing innovative things to improve healthcare delivery. Others are as well. Unfortunately, the efforts are too fragmented and not quite as comprehensive as we really need them to be.
    We can bring Obama and Congress in when legislation and regulation is required, but we’re not there yet.

  4. Really thoughtful post, Maggie! Agree on the black hole comment about more health spending.
    In addition to the Bush administration digging a hole, so did we citizens w/ our $10 trillion in consumer debt, mortgages we couldn’t afford, an obesity epidemic and the callous disregard of the unfortunate among us. There’s a pattern here, don’t you think?
    In other words, there should be really broad ownership of the sorry state of our country. It wasn’t just the Republicans that got us into this. And Obama’s cautioning people that simply electing him was the easy part, not the change that everyone wants, was a great signal of the need for sobriety and sacrifice to get on the right path.

  5. > But in fact, “mainstream” America is no longer one
    > recognizable culture. It is fast becoming
    > a “magnificent mosaic,” the phrase Mario Cuomo used
    > when he ran to become mayor of New York City in 1977.
    And this by misguided design. Remember the “melting pot” vision of America? Then, the idea was to create a common culture, or in other words, a society. Indeed a society flavored so to speak with the best of the world, but a society nevertheless with common mores and a common vision. The modern project has been to emphasize (indeed exalt) the individual, and replace unchangable “bonds of affection” with a set of very changable rules. This is called “progress”. It is entirely contrary to human nature — there has never existed an individual: every human being comes into the world a member of a society; the primary society of the family, the model for all human society and the source of its life.
    There cannot be social solidarity without a society, and a set of rules isn’t a society. Rules are made to be broken, when not broken then gamed to one’s own advantage. No sane person breaks or games his family: this behavior is reserved to enemies. We have progressed to the point that we are all enemies. It’s Hatfield vs. Hatfield now, never mind the McCoys.
    “if you plant ice you’re gonna harvest wind”
    — Robert Hunter

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