It has often been observed that what one sees depends upon where she/he is looking. This insight on human behavior surely fits our national debate on health care reform. Put in simplistic terms, if one has affordable health insurance, he/she wants to keep it. Those who don't have access to health care want to get it. Those in the first group are in the majority in numbers. The numbers without affordable health insurance are huge. They are tens of millions of people.
The variety of forces and influences that make up a nation's health care structure can in no way be understood in such simplistic terms. Those leading the debate - politicians, economists, public health and clinical health professionals, medical researchers, insurance industry experts, sociologists and psychological professionals - recognize the complexities. Put simply, like the current movie, "It's Complicated."
Like thousands of other Alaskans engaged in this political debate, I continue to listen to the millions of words and read thousands of pages our national debate on fairness in health care generates. In concert with a majority of fellow doctors, I am sure our system needs to increase equity of access and decrease waste. My experience as a physician since 1964, with 27 of those years in Alaska, convinces me that two changes are vital for our successful journey to better American health. The first is to eliminate our fee for service payment system. The second is to build a single payer system. As it is now, and has been for decades, the combined effects of fee for service and multiple-payers invites - indeed promotes - greed and waste for providers and clients. For those without access, the combination causes anxiety and suffering, including early deaths. No wonder the debate is loud and impassioned.
Many of my health care professional colleagues and informed fellow citizens are upset that real waste-cutting measures and the public option are not in the current congressional health care bills. Despite this, I sense the slow evolution of American health care is bringing effective and durable change. Our political leaders have finally stepped up to the plate. They have delivered a game-altering plan with some real changes. The public and private deliberations - and yes, also the political deal making - include sacrifices and compromises that affect all of us. In a complicated system, such is unavoidable.
In an open democracy, debate will be loud and sometimes offensive. Those with the most to lose may yell the loudest and try to persuade others with powerful fear proclaiming messages. I believe, as President Abraham Lincoln said "... you cannot fool all the people all the time." As the final health care bill reconciliation is worked out, the public will have its voice heard. By serendipity, the Massachusetts special election for a replacement to Sen. Ted Kennedy's seat will impact health care change legislation. It is also serendipitous that basic American compassion and know-how are now being shared with public and private cooperation - indeed truly international help - to aid our fellow humans in Haiti.
I am optimistic we will improve health for all Americans. Here's why: Although major media coverage from Afghanistan portrays dire military chances for success, Greg Mortensen of "Three Cups of Tea" fame is building a girls school in the very heart of Taliban country. As shown by Mortensen on the ground in building hundreds of schools for girls and boys in Afghanistan, when we listen to the universal and ageless hopes of mothers, we slowly evolve into a healthier and wiser world. What do Afghanistan mothers want? They want their children to live and to be well educated. When elected leaders listen to us and we listen to each other, we become healthier in many ways.
George W. Brown is physician living in Douglas.
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