Seeking a Diversity of Opinions in Health Care Policy

By Joshua J. Faucher

I returned two weeks ago from the Physicians for a National Health Program (PNHP) 2013 Annual Meeting, which took place on November 2nd in Boston, MA. It was the third PNHP Annual Meeting I have attended, and my first as a student member of the organization’s Board of Directors. I can say that the meeting was a rousing success, and that we had a record number of attendees (including over 130 medical and health professional students – the largest number ever)! Can I say, however, that we are approaching the final realization of our goal:  the implementation of single-payer national health insurance? Not by a long shot.

A full house at the morning session of the PNHP 2013 Annual Meeting. Acknowledgement: Photo by PNHP staff.

I’ll admit it; our organization is a bit fringe. This is in spite of the fact that single-payer national health insurance is utilized by our closest developed neighbor – Canada (with its decidedly federalized Medicare system), and by the country to which we can trace our heritage as a nation – the United Kingdom (with its more socialized National Health Service). Alas, during the most recent efforts to reform the health care system in the United States, single-payer was barely discussed as an option. When it was brought up it was denigrated as “socialism” without serious consideration of the real nature of single-payer or its merits.

On what can we blame this dearth of information, other than a lack of diversity of opinion? As a student of medicine and law, the need for this reform is clear. Patients, providers, and the majority of American employers all have an interest in expanding access to care for patients, and reducing the ballooning amount of spending in the health care system. The simplest way to do this would be via single-payer insurance scheme, which would facilitate the reduction and redirection of spending away from redundant and wasteful administrative costs associated with the private insurance scheme.

If you don’t believe me, get in touch, and I’ll explain it until your ears fall off. But should I have to? Shouldn’t the national news media give a clear and honest evaluation of an approach that works for so many other developed, capitalist democracies around the world? I find it hard to believe that the one industry that stands to truly lose from single-payer – for-profit health insurance corporations – can have that much of a stranglehold on the messaging.

As public perception of the Affordable Care Act’s implementation reveals it to be a bloated, unnecessarily complex subsidization of private insurance, I worry that the conversation about health care in the United States will drift towards budget cuts and austerity rather than a simplified social insurance scheme. Any steps toward austerity and further privatization of health care will collide head-on with looming crises in our retirement system and the financing of long-term care for an aging population. This could lead to a degree of social unrest rarely seen in our society. If progressive voices were a louder part of the mainstream media, our future demographic and socioeconomic shifts might be gentler.

Dr. Marcia Angell speaks to attendees at the PNHP 2013 Annual Meeting. Acknowledgement: Photo by PNHP staff.

All the same, I realize that PNHP as an organization could also use more diversity of opinion.  At the Annual Meeting, our lunch speaker was Dr. Marcia Angell, a former editor of the New England Journal of Medicine. She received a strongly positive reaction from the crowd when she extolled the virtues of a system that would go farther than single-payer – one that would nationalize the entire health care apparatus and eliminate private interests and the destructive aspects of the profit motive in health care delivery.

On the one hand I found myself agreeing with her; the corporatization of health care delivery has its own set of negative effects, and a system like the UK’s National Health Service would be the most efficient and equitable way to distribute the resources of the medical system. As this idea was reiterated throughout the second half of the meeting, though, I also found myself growing apprehensive. I know that many of my medical colleagues would not accept a scenario granting the government near complete control over health care providers, and I know that if PNHP makes purely socialized medicine its message then we will lose the opportunity to gain numerous allies in the private delivery system. In fact, when presenting the idea of single-payer to new audiences, I make sure to draw the distinction between the financing scheme and the delivery system, and to point out single-payer’s ability to coexist with privatized delivery.  I take these steps in order to shield the topic from emotionally charged and politicized label of “socialized medicine”.

Members of the Mayo Medical School chapter of PNHP in attendance at the PNHP 2013 Annual Meeting (left to right): Dominic Caruso, Sharon Kim, Josh Faucher, Swathi Damodaran, Ashley Cobb, and Eric Jackson.

The only way to build a coalition large enough to affect true social change is by meeting in the middle, and by engaging in compromise. Just as the national conversation must feature progressive ideas to achieve effective reform, PNHP and other groups must temper ideological purity with a realistic approach to building consensus. After presenting ideas from the full spectrum of economic and social approaches to fixing health care, we must look beyond ideology to objectively evaluate our diverse options.

Unfortunately, our current political system favors polarization and concentration, rather than diversity, of opinion. Sadly, the increasing inter-connectedness of our world seems to make it easier for us to cloister ourselves among those with whom we already agree, rather than to be challenged by new and unanticipated positions. Diversity of opinion breeds compromise, and compromise facilitates stability in our personal and societal relationships. We should work together to elevate small voices instead of drowning them out, and to always give a little when we expect to get something in return.

On November 7th, 2013, MMS-PNHP hosted TR Reid, reporter and creator of the Frontline documentary Sick Around the World. Pictured above is TR speaking at the Mayo Clinic Center for Innovation Transform 2013 conference the following day. Acknowledgement: Photo by Andrew Harrison.

Josh J. Faucher is a student in the joint MD-JD program between Mayo Medical School and Arizona State University. In 2011, he and Andrew M. Harrison co-founded the Mayo Medical School chapter of PNHP (MMS-PNHP).

Josh Faucher at the Sandra Day O’Connor College of Law in Tempe, AZ. Acknowledgement: Photo by Layne Bettini.