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The Semantics of Reform

In my last post I encouraged everyone to watch the health care debate at Blair House mediated by President Obama. For this, I must apologize — I ignored the maxim that one should neither watch sausage nor laws being made. I had arranged to work from home that February 25 since I planned my next post to be a review of this much touted debate.  As the proceedings began, I felt cautiously optimistic as I watched our politicians gather to supposedly mediate their differences; yet as the sun set that day I was incognizant of any path towards meaningful reform that our elected leaders could set upon as a result of their interaction.

Webster’s online dictionary lists two meanings of the word debate, with the first being: “a variance of opinion on a matter,” which best describes my recollections of that day.  However, the other definition: “a careful weighing of the reasons for or against something,” may better explain my hopes of what would transpire because of the debate, but fails to describe what really occurred that day.  The realization of this fact only deepens my disenchantment with what Washington has created and now dubs “Healthcare Reform.” When I try to recall the actual debate, I hear within my mind lots of static and background noise yet I can recall nothing of significance.  What I hear reminds me of the voice of the schoolteacher from the Charlie Brown cartoons I watched during my childhood.

The success of this one and only healthcare debate was imperative for reform. President Obama has oft spoken the sentiment that “Reform is a necessity, not a luxury,” and I believe this statement to be considered a fact by anyone working inside the health industry today, including me.  The current fiscal realities our country faces today only serve to strengthen the argument for reform.

But what is reform?  It seems every politician in Washington is beating the drum for reform while disagreeing with each other as to how to enact it.  Republicans disagree with Democrats.  Blue dog Democrats disagree with Non-Dog democrats and, I think, most other Republicans. The President disagrees with Republicans and is pressing reluctant Democrats to get on board.  Abortion has seeped into the reform debate like it does most every bill of social consequence in our country.  The whole thing is enough to give anyone interested in real reform a headache.

I wish a headache were all that the debate left me feeling, but I am also anxious and worried.  If I am to adequately convey my fears about the beating of so many different political drums, I would call to mind not just the definition of reform but I would point out the natural tendency of politicians to act — even if the consequences of the action are unclear.  This is antithetical to most physicians who, as scientists, try to tailor a treatment towards a specific disease while planning for a specific outcome.  For example, we would not give chemotherapy to a patient with an unclear diagnosis- just to do something.

So back to semantics, briefly, I promise.  You see, reform as a verb simply means, “to form again” and our politicians, big on action, have amply demonstrated their willingness to plod ahead time and time again with uninspiring results, thus my concern.  As a noun, reform means, “to improve or amend what is wrong” and that implies actually leaving a thing better than you found it. This is much harder to do.

Am I wrong to have such fear?  When I express my concern that politicians will make health care worse for patients, employers, and doctors, do I sound crazy? Perhaps, this time I should hope our government will finally get it right.  Maybe I shouldn’t look towards our politicians past actions to predict future outcomes.  Yet, as a physician I have been trained as a scientist to peer into the past to understand future possibilities and so I choose to close with the words of a famous scientist, Albert Einstein……”The definition of insanity is doing the same thing over and over again and expecting different results.”



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