Dear President Obama,
Before you even took office you asked us Americans to share our ideas about health care reform with your new Administration. Thousands of us, thrilled to be invited to participate, gathered in small groups and offered our vision to you. Now, tonight, as you address us, it's time for you to give us back our vision, enhanced by your broader perspective, enriched by detail, unencumbered by fear.
I'm sure you and your advisors have seen the polls that have repeatedly shown that the vast majority of Americans (up to 85%) believe that our health care system needs to be "fundamentally changed and completely rebuilt," and that almost equal numbers are concerned that "access to medical tests and treatment would be more limited" as a consequence of health care reform. The polls tell us that Americans know that our far more expensive health care system is significantly less effective and efficient than that of other developed countries, and that, in general, we like the doctors who care for us.
These apparent contradictions are best understood as Zen koans, paradoxes that work to boggle our minds prior to opening them to new ways of seeing and thinking. I hope tonight you will invite us to look at health care reform in such a new way; help us to find, beyond the fears that have been evoked, and the mind-numbing horse-trading and compromise of the legislative process, the vision that continues to animate your commitment to the health and well-being of all Americans.
The vast majority of Americans - not just "Democrats" or "progressives," but all of us - are decent, compassionate people who really want all our fellow citizens to have the health care they need. We know that change is necessary, but we don't know yet what's actually being proposed, and we fear that the change that comes may take away the surety of care and the security of our relationship with our doctors.
Fear is an enormously powerful emotion, deeply embedded in our evolutionary heritage and in our central nervous system. It signals danger, mobilizes the fight or flight response and all the psychobiological mechanisms of survival. Fear, as this summer's town halls illustrate, overwhelms our capacity for nuanced observation or even rational thought. The very thought of going to the doctor makes many people tremble. The possibility of failing health, or of a vulnerable old age, or a change in access to those who are supposed to care for us makes us deeply uneasy. When opponents of health care reform have used evocative and provocative words to summon up these specters, the fear factor has obviously jumped off the chart.
To our agitated minds, "rationing" means that we will likely lose the diagnostic tests which we hope will clear away threatening uncertainties, the treatments that may restore us to health, and the doctors whom we have literally trusted with our lives. "Death panels" signify that anonymous others will, in the name of some impersonal, financially motivated calculus, shorten our lives.
Outrage, reassurance, and careful reference to the actual texts of proposed legislation-the principal defensive strategies of health care reform proponents to date-only take the edge off our collective apprehension. Relaxed, even meditative, clear-eyed assessment of health care realities, active engagement of each person in responding to them, and a call to transcendent and common purpose are what will ultimately make it possible for us-individually and collectively- to move through and beyond the fears that have been dominating the discussion. We are an energetic, inventive people and once we know it is possible and even necessary, we will want to be actively, effectively engaged in our care, and in determining our destiny.
Think of the "terminally ill" mother, who "somehow" lives to see her daughter's wedding, the firefighter who enters a burning building to save an endangered child, the soldiers who brave bullets to protect one another. Think too, of people with life-threatening or life burdening illnesses (coronary heart disease, diabetes and cancer, clinical depression and post traumatic stress disorder), who, in the therapeutic programs many of us have created around the country, are healing themselves: sharing their fears and developing strategies for dealing with the threats to their lives; regarding illness more as a challenge than a disaster; eating and exercising in more healthy ways; learning from and supporting one another. William James coined the phrase, "The moral equivalent of war." Caring for ourselves individually and collectively is such an equivalent.
I'm asking you, really, all of us are asking you, to mobilize and inspire us to participate actively in our own health care; to insist that those professionals who are supposed to help us treat us respectfully, even lovingly, as active partners, not passive patients.
We don't, for the most part, need more drugs or procedures, but rather doctors and other health care professionals who will spend adequate time with each of us, listening and creating partnerships, as well as writing orders and prescriptions. The powerful therapeutic effects - and cost effectiveness - of such instruction in self-care, of what some are calling "lifestyle medicine," on outcomes of chronic illness have been repeatedly documented.
If every older person were guaranteed a physician with time to talk about life and ways to live it more fully, as well as to discuss the best ways to deal with the inevitability of death, debates about "death panels" would wither from lack of fearful fuel. If doctors spent more time looking at the excess of often clashing and contraindicated medications that older people take, much of the unnecessary suffering and fear that accompanies care in old age would disappear. As we actually learn what combinations of self-care and physician-administered therapies are most effective, for which condition, most concerns about rationing-raised now almost entirely by drug companies, which fear that their products' flaws will be revealed- will dissolve. We need to hear clearly from you that all those individuals and institutions that profit from our pain - hospitals, insurance and pharmaceutical companies, and those of us who are doctors too - can be justified and supported only as long as they serve all of us.
Finally, you must assure all of us, left, right and center, that you and your Administration will continue to give us and our health care the careful consideration we deserve, that this present effort is only the first stage of health care reform; the beginning of a process of national education; and a framework for the more profound and pervasive changes that we want but are not yet sure how to achieve. Tonight, we need you again to inspire us, to give us a vision not only of how we can all be safely and effectively treated, but how we can thoughtfully, lovingly, energetically, even joyously, learn to better care for ourselves and one another.