The Modesty of Hope

The debate over health care reform has rapidly morphed from a discussion of the risks and rewards of proposals to improve our health care system into a much larger, broader debate that has very little to do with health care. In town hall meetings and on cable networks, in blogs and over dinner tables, we are now arguing about our hopes and expectations for the American Dream.

Since the dawn of the Industrial Age, and even before, there has been a deep strain of exceptionalism in the American character. The idea is that America and Americans are somehow special, masters of our own destiny in a chaotic and uncertain world, able to exert both our moral leadership and economic might to lift humanity to a higher place. With the misguided war in Iraq and the economic missteps that lead to the greatest economic meltdown since the Depression, American exceptionalism -- and with it the American Dream -- has been brought sharply into question.

Even President Obama's "audacity of hope" rings with echoes of American exceptionalism. "We are a great people" was the implication, "and if we simply recommit ourselves to the American Dream, we can again triumph over adversity and despair." After a rough month in which the health care debate escalated into a screaming match and Americans began again to view the national glass as half-empty, questions about exceptionalism and the American Dream have resurfaced.

The health care debate has become a microcosm for those questions. Essentially, there are three critical issues at play in the health care discussion -- equity, efficiency and quality of care. The health care system is clearly inequitable -- only those who can afford insurance or who have no pre-existing conditions will be given full access to medical care. The system is also clearly inefficient -- we spend more on health care than most nations and have poorer results. And the quality of care is uneven -- it ranges from unrivaled Cadillac treatment for some conditions and individuals to extreme neglect in areas like preventive care and care for the uninsured.

Each of these critical issues has its advocates on both sides of the political spectrum. While some want more equity in the system, others would like to see more efficiency, and still others fear a loss of quality care. But what few of the proponents of the various policy positions acknowledge is that there are not many realistic, affordable options that address these issues. Universal, single payer coverage is likely beyond our means, certainly at the level of care we now provide. The European nations and Japan have discovered this and are facing their own health care crises. Efficiency in the health care system is unlikely to come quickly and will certainly not provide the cost savings that many people -- including the President -- envision. And, finally, the high quality health care that has been delivered in the past, albeit inequitably and inefficiently, is no longer affordable.

What this means is that we, as Americans, must accept at some level, an unequal, inefficient, lower-quality health care system. Right now, most people are not willing to do that. They want to cling to what they have, even if it means an expensive, cumbersome system. In the end, it is the devil we know rather than the devil we don't know. However, America's corporations and businesses have announced with great clarity that they are no longer willing to pick up the tab for an expensive and inefficient system. At that point, the only other payer is the American government, i.e. taxpayer, who will pay either in the form of subsidies or a direct government program.

We are, therefore, at one of those peculiar moments in history when our destiny is clear, but we are unwilling to embrace it fully. The American Dream has been diminished, and we can no longer rely on American exceptionalism -- or even the audacity of hope -- to restore it. What we can do, however, with modesty and humility, is to accept our somewhat diminished circumstances and, counting our many blessings, proceed to forge a path forward that preserves our fundamental American values of equality, integrity and common sense. Perhaps it is audacious to hope -- as President Obama did in his campaign -- that we can come together to forge a common solution to adversity. But we must begin with modest hopes and modest goals.

Follow Hoyt Hilsman on Twitter: www.twitter.com/HoytHilsman

Comments

[dennis181]

Strong post, with an important theme. We have to accept our dimininshed circumstances if we're to have an intelligent debate on health care reform. And make no mistake: despite the rantings of armed (!) partisans at the town hall meetings, we need to make changes to the way health care is delivered in this country. I just hope that sober debate is still possible in this Interent-fueled media age.

[NeverGuessing]

As a Conservative entrepreneur it bewilders me as to how little thought anyone has put into "Change you can trust," We are not defeated, we haven't even gotten started. Solutions you will not hear from the Hill.

1. Remove the medical/ins Co, except for R&D, ability to list on Wall Street. Get back to insurance agents and not stock gurus..

2. Campaign finance reform. Eliminate the money flowing between Government and Medical/Insurance Companies.

3. Experiment a little and have a public plan. Must turn a profit in 3 years like the rest of us.

4. 8 year restriction on retiring Senate or Congress employment with corporations upon leaving office. As Civil Servants they can go back to their old employment.

5. Who are the major stake holders in the Federal Reserve? One month to comply with transparency or "We the People" move to a new currency.

6. Tort reform. Lets eliminate an excuse.

7. Regulate the industry and remove all subsidies.

8. Give back the "two thirds" that Obama has recognized as waste.

9. Stop the Pentagon 25% leak and find the $2.3 Trillion thats lost.

10. Regulate the industry unlike any other. Actually do it.

They keep placing band aid over band aid and call it "Reform"...

[modwiz]

All this post has to offer is that we can't have single payer, that the Europeans and Japanese have a crisis. He offered no solutions other than wanting less, except for the insurance companies. By excluding one of the biggest problems in health care it is obvious the article seeks to distract us from this problem. Hoyt is disingenuous at best.