Taking Stock of Health Care Reform

Written by: Michael Pine on Aug 3, 2009 9:14 AM EDT

As Congress prepares to recess and the media revel in stories about how the President's attempt to reform health care is on the ropes, it makes sense to take serious stock of where we are and where we may be going.

In advocating for meaningful health care reform, our first task is to identify our target audience. Haranguing people who are not persuadable is an exercise in futility that is best avoided. Although it is very frustrating to hear people say ridiculous things knowing for sure that they would instantly reject these unsupportable fairy tales if only you told them the truth, many of these people are not merely ignorant of the facts. Because their stated beliefs actually are masks concealing what's really in their heads and hearts, simply telling it like it is will do nothing to alter their political positions.

Short-term objectives are what most concern ordinary citizens who place immediate pain and pleasure ahead of future risks and benefits. Their past experience is filtered through a prism that aligns what they know with what they want. This means that most people's political positions are based not on facts but on perceptions grounded in personal needs and desires. Effective political persuasion is not the art of eloquently advocating our beliefs; it is the art of speaking directly to the condition of others. Don't expect others to trust authoritative statements that trivialize their understanding and denigrate their concerns as groundless.

People must move from where they sit before they are ready to come to where we stand.

It is easy to contrast our politics of hope with our adversaries' politics of fear. But let us never forget that safety is one of the most basic human needs. Most people will support change only after they are convinced that the things they hold dear are not endangered. "The only thing we have to fear is fear itself" is not a denial of the legitimacy of fear; it is a cogent promise of personal and collective security from external threats.

During the next month, while Americans are taking stock and consolidating positions on health care reform, this blog will attempt to provide perspective and focus activity where it will do the most good. To do this, we have selected the following four high profile issues about which there are serious differences of opinion and genuine political conflict about how to proceed:

1.The role of the federal government in health care with particular emphasis on the "public plan";

2.The cost of health care reform with particular emphasis on economic growth and the federal deficit;

3.Payment for health care reform with particular emphasis on taxation, mandates, employers' responsibilities, and fair play; and

4.The urgency of now with particular emphasis on whether a patched together third best plan is better than nothing at all.

Each issue will be the subject of a blog structured as a conversation. One contributor will advocate a progressive approach to the issue, another will present reasoned conservative counter-arguments and alternatives, avoiding the lies and name-calling that often pass for political debate but doing her best to give the devil its due. A third blogger will explore ways in which legitimate concerns of left and right may be reconciled. We hope that this approach will enable us to get beyond the knee-jerk, minute-by-minute responses that often characterize communications from both extremes. Finally, each blog will conclude with a set of high priority action items for the coming week.

Let's remember that we aren't engaged in an academic debate about health care. Instead, we are up to our eyeballs in the politics of health care reform. In a debate you attempt to educate, in politics you attempt to influence and persuade. So by all means, let's get the facts out there. But as the battle over health care reform progresses, more and more people will take positions based not on ignorance but on reasoned judgments of what reform will look like if it is enacted. The unknown always is scary and, in the end, the human tendency is to "rather bear those ills we have than fly to others we know not of." Our job is to address genuine fears and concerns, not by denying their existence, but by countering them to alter the political calculus in favor of the changes we so fervently desire.

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