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Caplan: Think Big on Health Care

Arthur Caplan reminded us last week not to get bogged down in the details and to "think big" on health care. To read more about what he said, click here or read the full text of his MSNBC column below.

Summer Johnson, PhD

Details, Schmetails: Think Big on Health Care

As the debate over health care reform heats up this summer, the new battle cry of those who oppose change is that overhauling the nation's health care can't work because reform is "all in the details." And the details, the critics say, don't add up.

Republican critics in the House and Senate along with the American Medical Association, the United States Chamber of Commerce and the pundits of right-wing talk radio, TV and blogs are warning daily that without the "details," health reform cannot possibly proceed.

They demand mind-numbing minutiae about such things as comparative effectiveness research and information technology programming.

A larger load of baloney masquerading as an argument could not be imagined. The success of health care reform is not in the details.

Think I'm wrong? Details killed the early '90s Clinton effort at health reform. Hillary's team had stacks and stacks of details. In fact, they produced a magnificently detailed 1,800 page plan that became the unreadable, unsellable playbook of a movement that collapsed under the weight of its own detailed dilatory prose. None of this was of any help whatsoever to the nearly 50 million Americans without health coverage.

No one except for the critics looking for some way to derail health reform gives a hoot about the details. OK, a few others care.

Details fascinate the wonks, nerds and pointy heads that our very bright president has, thankfully, surrounded himself with to help figure out how to implement reform. And when challenged by critics every impulse of the wonk posse is to get the president to pile on more details.

Details are what the media long to report and you lust not to read. Details are the droppings of inside-the-Beltway gossip intended to impress your host or your date. Details, however, are not the key to health reform.

No nation on earth has ever reformed its health care system by asking the public to wallow around in the details. Canada, Britain, France, Germany, Switzerland, Australia, New Zealand and all of the other nations boasting universal health care coverage did not assemble their finest numbers crunchers and pencil pushers and send them into the front lines of the battle to sell reform.

Do the right thing
What matters in health reform? How about doing what's right?

Specifically, what is going to determine whether health reform can be pushed through by the well-intended Obama administration is the answer to one single, fairly simple ethics question: Is health care a right that every American should have? That is what Obama needs to continue to stress. If he can sell the American people on the idea that they have a right to health care, then the details will all be worked out in time. If health care is not viewed as a right then the details are the boggy swamp where reform goes to die.

Not so long ago I gave a speech to a group of about 75 influential hospital executives. Before starting my talk I asked how many of them thought health care was a right. About seven or eight did. I knew there and then that the fight to reform our broken, costly health care mess of a system would be all uphill.

In some societies, health care is seen as a right because it has been earned. The British National Health Service was created in response to the British public having endured the Nazi blitz for many awful years.

Some societies see health care as a right because a healthy work force means a stronger economy. That was the basis for health care reform in Germany and Singapore. And, in some nations, health care is seen as a right because of the ethical belief that a community should look after its own. Switzerland, Canada, Australia, France and New Zealand have grounded their right to health care in this idea of social solidarity.

Equal opportunity
The American public isn't likely to bite on any of these propositions. But there is another argument that speaks directly to a notion we Americans embrace -- equal opportunity.

We believe all Americans have a right to a basic education for this very reason. And isn't your health as essential to thriving in the free market this country so loves as your schooling?

Imagine if our nation had set out to establish public education with this same detail-bogged mindset instead of a commitment to attempting to level the playing field for all children.

Well, that playing field turns into a steep cliff when a child's medical needs aren't guaranteed.

Forget the details, Mr. President. Do not get bogged down talking about them. Leave them to Congressional staffers, the Office of Management and Budget, academics and lobbyists. In other words, the wonks, nerds and pointy heads.

You need to keep your eye on the prize -- creating a health care system that fulfills every American's right to decent care. If you constantly remind the public that health care is a right and the most basic underpinning of equal opportunity, Americans will demand that the details simply get worked out.