THE BLOG
05/04/2010 05:12 am ET | Updated May 25, 2011

Why Is Health Care Reform So Difficult?

Why is health care reform so difficult? Why does it have to be this way? In the wake of the Health Care Summit and the President's acknowledgment that there are honest and substantive differences in how we approach health care reform, the columnists and pundits are trying to answer the same question that people of faith have been addressing for years.

With the diversity of political views in the Faithful Reform in Health Care coalition, we have sought meaningful ways to engage in values-based reflection around this century-long struggle. Through study materials, dialogue opportunities, PowerPoint presentations, workshops, and just plain good old coffee-break conversations, thousands of us have pondered what has made the debate about health care reform so contentious. Ultimately, our answers are framed as five challenges, hoping that they are not permanent barriers in our ability to move forward.

Challenge #1 - Moral Vision. The underlying challenge is the absence of a strongly articulated moral vision. Do we want a health care future that includes everyone and works well for all of us -- or not? Without a clear answer to that question, reform efforts remain locked in conflict over competing views about the soul of our nation and where our responsibilities lie in caring for one another.

Over the years, we have accepted a collective moral responsibility for our most vulnerable populations -- those with the lowest incomes, our elderly, our veterans, and our Native American and indigenous populations. The crisis facing us now is what to do about the 123 persons who die unnecessarily each day (5 per hour!) - plus the millions more who risk that possibility for lack of health insurance.

While most members of Congress would likely profess an individual belief that everyone should have needed health care, the lack of a national moral vision becomes evident as proposals are developed. Deliberations are informed by questions that focus on how much money is saved or what industry is protected, rather than on the persons who are left out as a result of the negotiations. Whether our goal is everybody in (or just some people) impacts how all other questions are answered and how challenges are overcome.

Challenge #2 - Access or Costs. Is our goal to improve access in spite of the cost, or to restrain the growth of costs by reducing access and/or quality? Historically and in the current debate, because these goals are often seen as contradictory, legislative efforts usually have polarized around one view or the other. Because we don't start with a commitment to include everyone, we argue over just how many/few more can be covered, and at what cost. If money were no object, increasing access would be much less troublesome. But resources, though abundant, are finite, which means we have to practice faithful stewardship in using them. The difficulty lies in determining how to distribute these resources equitably and how to assess who will bear the burden for keeping costs in check.

In spite of the politics that might suggest otherwise, the truth is that successful reform will encompass both goals: improving access and containing costs while maintaining a high quality of care. Neither goal can be fully achieved by itself; comprehensive reform will be impossible without a commitment to both. All other industrialized democracies have found ways meet both goals, and so must the United States.

Challenge #3 - Marketplace or Government. The moral dilemma informs differing perspectives around the relative roles of competition and regulation. Are human needs better served by markets, individual ownership, competition and profits, or by governments and laws that guarantee access and a fair distribution of costs and services?

Extreme ideologies in our country have failed to recognize that modern health care systems actually exist somewhere between unfettered free markets and full government responsibility. A system that consumes one-seventh of our economy yet fails millions of us would benefit from both increased public accountability to protect the common good and improved private initiatives to encourage quality, innovation, and efficiency in covering 300 million people. The most reasonable voices for reform understand the need for partnerships among all sectors to make this system work. The attempts by both sides to polarize the debate must be transformed into expectations that lawmakers will find solutions that demonstrate a creative mix of effective government regulation and fair market incentives.

Challenge #4 - Political Partisanship. The three previous challenges and how legislators respond to them feed the political partisanship that paralyzes our efforts to achieve major reform. In spite of an initial goal to make health care reform bipartisan, the two political parties champion very different sets of principles. The decline in cooperation between the parties has limited their willingness to overcome those differences and to seek consensus for the common good. In spite of broad and deep public support for reform, and in spite of numerous bipartisan agreements and compromises in the bills, legislators continue to fall into the usual and comfortable circles of partisanship. Party loyalty helps guarantee upward mobility, leadership and membership on key committees, funding for upcoming electoral bids, and campaign contributions from powerful stakeholders.

Ultimately, it will be dialogue around shared values, rather than debate over competing ideologies, that will build bridges that lead to the possibility of transforming the public conscience and creating the legislative priorities for successful and sustainable reform.

Challenge #5 - Economic Self-interest of Key Players. Almost everyone in the United States would benefit from health care reform. Some groups -- low-middle income workers, persons with pre-existing medical conditions, the uninsured, racial and ethnic minorities, people living in under-served areas -- stand to gain a lot. But a number of well-financed, tightly organized health care industries and trade associations fear what they could lose. In spite of concessions to keep them engaged as supporters, in the end, they are now using their influence and affluence to derail reform.

As long as the discussion is dominated by those who fear the loss of their profits, the rest who have so much more to lose will continue to be crushed by the inequities and injustice of U.S. health care. Ultimately, strong public demands for change, coupled with substantial campaign finance reform, will be needed to promote the common good as a benefit to everyone's self-interest and to prevent special interests from blocking progress.

Living into Our Health Care Future. Good people with good hearts and moral grounding sit on both sides of the aisle in Congress, seemingly unable to recognize the value in one another's perspectives. In spite of agreement that health care reform is about people, not partisan politics, the ideologies embedded in a two-party system make differences appear to be insurmountable.

Faith communities, however, with members representing the full spectrum of political views, are uniquely positioned to create the opportunities for dialogue and collaboration. In fact, in these moments, it is our calling to help move the debate surrounding health care reform from what is politically prudent or economically feasible to dialogue which embraces compassion and justice and the common good. It is our task to transform these challenges into opportunities for moving forward by identifying the shared values that bridge the partisan differences.

In doing such work, it is in hopeful expectation that we will touch the hearts and minds of the American people so that together we may envision a health care future that fully embraces health, wholeness, and human dignity. It is in transforming our collective conscience on the issue of health care that we eventually will make comprehensive, compassionate and sustainable reform a reality.