“This is what change looks like”

A few months into the Obama presidency, a liberal friend tried to pin me down on my position on health care reform. Now, I’m not really hard to pin down—I support reform. I’ve been a pretty loud advocate for it. But he wanted to know my opinion on the public option, a measure he saw as essential. I was reluctant to take a militant position on the public option, not because I didn’t see it as a good idea (I do) but because I didn’t see it as the silver bullet of health care reform.

About the same time, I was arguing with conservative friend who thought that the Democrats were just trying to create a huge entitlement program for all the unemployed people, in effect (he argued) “buying” their vote with the currency of health care. I replied that health care reform isn’t about free goodies: it’s about making all of us more economically secure, regardless of whether we’re employed or not.

With such a contentious, divisive issue, I found myself again and again drawing on my experience with people who are actually in the health care industry. I’ve been watching and listening for more than ten years as industry people talked about reform. What I hear over and over again is that our health care system is broken, unsustainable, heading for disaster. I hear words like “catastrophe” and “crisis.”

Year after year, I’ve heard people talk about the failures of our system. And it was more than talk. The doctors and health system people—as well as many the insurance side, knew all too well how real lives were being damaged by the lack of access to health care. They saw the price people paid for being uninsured. We heard those stories over and over again. But when the speech or the conference was over, everyone would go their way, until the next conference or speech.

There just wasn’t enough consensus on how to fix the problem. And I frankly questioned how we ever would find consensus, given the entrenched positions of people, not only politicially, but from their different places as stakeholders in the industry.

One of the really remarkable things about this health reform campaign of the last year was how Obama was able to get industry players on board. The American Medical Association. The drug companies. AARP (representing the Medicare constituency). Even the health plans, though generally opposed, were muted in their criticism because they simply could not make the argument change was not needed.

You can certainly turn that around and say that Obama has sold out to the special interests. But the bottom line is that it would be impossible to bring about reform without the industry being part of the pro-reform team. Unless, of course, it was done with as a kind of top-heavy, big government takeover of health care—outlawing private insurance and replacing it with a government system, for example. In this political climate, who thinks that would have worked?

There were many times during this process I thought health care reform was dead. But time proved me wrong. Just as it has proven Obama right. This is what change looks like. It’s a long, hard, contentious process, and even when you get to the “end” there’s much more to do.

People voted for change in 2008. They voted for health care reform—it was a major campaign issue. They voted for a new approach to our economy and our politics. It’s been a long, hard, contentious battle for those things so far. But we have a president who is delivering on his promises.

And we have passed health care reform in the United States.