Health Reform-Health Speech 6/4[/98] [Harvard Medical School Commencement] [3]
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OCR Page 1 of 60IEL:
ridy 10 yo
1.21 NU UUZ
HA Spring 1995 SLUG: Reinhardt Perspective
Author Galleys - 27 February 1995 Page 1
1
HEALTH AFFAIRS
Spring 1995
Turning Our Gaze From Bread And Circus Games
by Uwe E. Reinhardt
Daniel Yankelovich argues that this na-
1993-1994 was not just a technical dispute
tion's recent attempt at health care reform
over alternative means of reaching a widely
failed largely because the American public
shared goal. It was a fiercely fought ideologi-
failed to "deliberate" properly on the issue.
cal battle over the goal itself. The nation's
By "deliberation" Yankelovich mcans"mull-
leadership class was and remains deeply dì-
ing over" the costs and benefits of alterna-
vided over the ethical precepts that should
tive choices and making tough choices, all
govern the distribution of health care.
in a serious "give-and-take" with the na-
At one end of the ideological spectrum
tion's "leadership class." Yankelovich places
are the pure egalitarians who would like to
blame for the public's failure to deliberate
see health care treated as a social good to be.
squarely on the shoulders of the leadership
made available to all members of society, on
class, which, according to him, deliberated
equal terms, regardless of a person's ability to
only within its own ranks.
pay for it. This school of thought would like
Embedded in Yankelovich's grand thesis
to see health care financed collectively,
are three hypotheses that warrant closer
through mandatory contributions that vary
scrutiny: (1) The leadership class itself prop-
strictly by households' ability to pay and
erly "deliberated" on health care reform but
certainly not by the health status of a house-
failed to communicate the product of that
hold's members.
"deliberation" to the public; (2) there exist
At the other end of the ideological spec-
channels of communication through which
trum is what one may dub the "food people."
the leadership class could, if it wished, en-
They are puzzled why anyone would make a
gage in a "give-and-take" with the public;
distinction between health care and other
and(3) the public is intellectually and tem-
basic, private consumption goods, such as
peramentally predisposed to "deliberate"
food and housing. As Rep. Richard K.
sincerely on complex issues of public policy
Armey (R-TX), a newly elected leader in the
and to make the tough choices in a lengthy
House of Representatives, put it to The Wall
conversation with leaders.
Street Journal in his inimitably blunt style:
The validity of these hypotheses can be
"Health care is just a commodity, just like
questioned. Indeed, they strike me as uto-
bread, and just like housing and everything
pian, as does Yankelovich's strategy for fix-
else." The "food people" regard the procure-
ing the "disconnect" between leaders and
ment and financing of health care as chiefly
the public.
the responsibility of the individual, whose
own behavior is thought to be a major deter-
minant of his or her health status. To be sure,
Deliberation In The Leadership Class
the members of this school of thought do
admit that the etiology of illness can be
When America's leadership class sets out
external, and they are prepared to guarantee
to debate health policy, its members invari-
the poor and near-poor at least a basic ration
ably preface their deliberations with the
of critically needed health care. At the same
mantra: "We all want the same things in
time, however, they see nothing wrong with
health care. We are merely arguing over the
a health system in which the quantity, time-
means to that end." This is utter nonsense.
liness, and quality of the health care received
The great health care reform debate of
by American families varies systematically
and positively with household income. If
one believes, as this school of thought tends
Uwe Reinharde is James Madison Professor of
to believe, that the American economy is
Political Economy at Princeton University's
the closest approximation worldwide to a
Woodrow Wilson School of Public and Eco-
nomic Affairs.
true meritocracy, then an income-based
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