01 February 2007

Blue ribbons again

The Colorado Blue Ribbon for Health Care Reform met on Tuesday and Wednesday for a retreat and business meeting. The 24 commissioners and three staff people spent about 20 hours together, and understand one another better now.

I’ll be posting this ad nauseum, in part because this group is so typical of opinion leaders across the United States.

There are moderates and conservatives; an advocate for the poor, an advocate for the African-American community, an advocate for the disabled, and an advocate for labor; business and healthcare CEOs and executive directors; and a ranting, aggressive libertarian who leaves everyone else feeling attacked and having to compromise — rightwards from their already tentative, centrist positions. And don't think that those "advocates" balance the group: at least two of the four are centrists.

And they're all pulled relentlessly rightwards.

Here’s an example of how this works.

A couple weeks ago there was an article in the Rocky Mountain News complaining that the generally agreed upon number of 46, 47 million uninsured is vastly inflated.

When the group was going around sharing how they felt, Linda Gorman, the libertarian, offered no vision, but rather her usual tirade against the unfairness of living in community. “The way public programs always work is that they expand into oblivion,” she said.

Then it was Allan Jenson’s turn. Jenson, an independent insurance broker had earlier told me that Americans wouldn’t accept anything other healthcare system than what we have right now because they won’t accept any limitations on what they can buy. He admitted that he knew nothing about France’s system, and the fact that there aren’t limitations there on services, or waiting lists — because the French and most other Western European nations adequately fund their healthcare programs.

On this day Jenson sadly noted that “we live in an era of resource limitations.”

He repeated that the number of uninsured is abused. He doesn’t think Colorado has 780,000 or so. He thinks it’s actually about 200,000.

There were general murmurs of agreement.

Daniel Stenersen, president and CEO of Shalom Park, a long-term care facility and a Democratic appointee, asked the group how much society was going to spend to prolong lives. “How much are we willing to spend on irresponsibility?”

“Then you have this whole notion of a perceived right to service,” Stenersen said. “I’ve struggled with this. Big time. Does a 94-year-old woman have a right to all expenditures that could conceivably be made available to her?”

This is an argument akin to the Right-To-Lifers pulling out the one about the abortions on 8-month, viable fetuses. It's something that doesn't happen. It's taking an extreme and trying to make the law around that vanishingly rare instance.

Barb Yondorf, senior program officer at the Rose Community Foundation, provided a nice counterpoint. She referred to John Rawls’ wonderful framework of helping us judge whether systems are fair or not. Rawls asked us to imagine ourselves parachuting into a society, without knowing whether we’ll be at the top, the middle or the bottom; black or white; disabled or perfectly formed; with a single, alcoholic mother or with a loving and wise extended family.

Would you choose the United States or Belgium?

I'm not sure everyone can usefully use Rawls idea to become more empathetic and objective. You have to squelch the ego that insists you'd overcome anything, and the judgmental attitudes that help many of us blame the poor without remembering all the elements that go into poverty. Rawls' framework doesn't work if you don't have an imagination.

If that's the case, you can continue on believing that wealth should be able to buy anything, no matter what the social and moral cost and that it's all right for the poor to not get anything — even life itself.

No matter what the social or moral cost.

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