29 August 2007

The Science of Change

How do people change?

After a rough day yesterday, I was ready to say that they don't.

Former Governor Dick Lamm autographed his latest book for me, writing that single-payer advocates should keep up the good work: "History is on your side," he wrote.

I wasn't sure at all yesterday that was true. I'd just met with a progressive Denver group about a vigil to be held on 28 September for the victims of our health care system: 18,000 a year, 50 a day — including my brother. The spokesperson for the group wasn't as interested when I said that no, Michael Moore wouldn't be at the vigil.

Beyond that, the group's leader said they'd be happy with any reform proposal for Colorado that comes out of the 208 Commission — or actually, they'd be supportive of any progressive proposal.

I said there was only one progressive proposal that the commission was considering: the single-payer proposal from Health Care for All Colorado.

The person shrugged and said the group has members supporting all of the proposals. No doubt true — all but the underwriters' proposal, anyway.

SEIU has a proposal that has very meager benefits with a $35,000 cap — meaning that if you're in an accident forget staying out of bankruptcy. It would leave 465,000 uninsured of Colorado's 780,000 currently uninsured, at an additional cost of about $600 million. On the plus side, they don't have mandates to buy shoddy products from for-profit companies.

A group of safety-net providers has a proposal that would have both individual and business mandates to buy inadequate insurance, further enriching insurance companies, adding to the numbers of underinsured, and expanding the safety net. It would add $1.3 billion to the current total state health spending of $30 billion, with about 100,000 still uninsured.

The underwriters have a proposal that would have individual mandates to buy insurance, but no business mandates. A $50,000 cap. It would leave about 133,000 uninsured, and cost another $271 million.

Health Care for All Colorado's single-payer proposal would SAVE $1.4 billion — lowering that total health bill in the state. It would cover everyone. Three-quarters of Colorado's households would pay less for health coverage than they do now. Colorado businesses that currently insure their employees would pay less than they do now. The benefit package is a rich one.

So which is the progressive proposal? Which is the sustainable proposal?

When I heard this group would not be backing the single-payer proposal and wouldn't co-sponsor the vigil, I couldn't stop my eyes from crying. Damn eyes.

It doesn't hurt when conservatives spread their misinformation. Today's paper had a conservative columnist saying that the great challenges of the Republican party will be to maintain troops in Iraq and keep private health insurance. Eh.

What hurts is that the people who should be behind single-payer have convinced themselves that they're smarter than that — that there has to be an interim step between injustice and justice. What would that have looked like with ending slavery? With the Civil Rights Movement? And when they say that change is impossible, it makes it impossible. We won't get to single-payer until progressive groups embrace it. We'll never convince the social Darwinists and libertarians. But these folks should be with us.

It was therefore a relief to read Susan Rosenthal's The Science of Change: How it Happens and How it Doesn't. She lays out a strategy of hope. The three parts of change are:
Social support. People need support from others to overcome feelings of powerlessness, to create strategies for change and to act on them. In the context of supportive relationships, we learn that we are neither crazy nor powerless. By pulling together, we give each other hope and strength....
Presenting problems as solvable. To change their behavior, people need to see themselves and the world differently, in ways that make change seem possible....
Michael Moore’s film, "Sicko," has made a huge impact, not only because it reveals the horrors of the American medical system, but because it shows them to be neither necessary nor inevitable.
Repetition. When the level of struggle is high, people seem to change overnight in a kind of explosive chain reaction. At all other times, the dominant ideas are those that maintain the status quo. Changing those ideas requires patient and repeated encouragement. It’s like boiling water.
You put the kettle on the stove and turn up the heat, but nothing seems to happen. Do you remove the kettle in disgust at the failure of heat to boil water? Of course not!
Forcing people to buy inadequate insurance from the industry that has created our healthcare crisis is taking the kettle off the fire. It's not progressive. It's capitulation. It's not what's "feasible." It's a dead end.

No comments: