So Much Hinges On So Few
One of my children was just watching the movie version of 1776, the musical show about the events leading up to and including the signing of the Declaration of Independence. In the Broadway account, the fate of the document, the fate of the world, came down to James Wilson of Pennsylvania. Pennsylvania was, indeed, torn between reconciliation and war with England. In a last gasp appeal, John Adams spoke out. "It would be a pity for a man who has handed down hundreds of wise decisions from the bench to be remembered only for the one unwise decision he made in Congress." Wilson (who, in reality, spoke forcefully for independence) relented. He didn't want the attention or the responsibility. "Mr. Adams is correct about one thing," he said. "If I vote with you [John Dickinson], I'll be the one who prevented American independence."
Healthcare reform and the signing of the Declaration of Independence may not be in the same league of American milestones, but the parallel struck me. Of course, there have been many, many instances where critical decisions came down to one unsuspecting or unprepared (or manipulative) person. But here we are. With the so-called public option going down to defeat in the Senate Finance Committee, it is now highly unlikely that any subsequent amendments with such a provision will survive.
And what does that mean? The table is set for Senator Olympia Snowe to play James Wilson. Sixty votes will be needed for passage and it's looking more and more like achieving meaningful (though highly compromised and far from perfect) healthcare reform any time in the foreseeable future will rest with the capable centrist from Maine.
The optics aren't pretty -- the old saying about laws being like sausages comes to mind. And what got us to this point hasn't been any more attractive. The raucous Town Hall meetings over the summer -- the shouting down of elected officials and the perpetuation of false claims -- did not instill confidence in the process of creating legislation. Politicians need to pay more attention to this point. The substance is important but, when it comes to building trust and unity, the visuals and the tone mean a great deal, too.
While one voice may decide the fate of healthcare reform, it's interesting to note which voices went largely unheard. The most vocal weren't those with the most to gain -- the roughly 46 million without insurance. The squeakiest wheels were found on those who believed that reform will diminish their care or cost them more money. They had the best access to the media, the best messaging consultants. So much for Life, Liberty and the Pursuit of Happiness for the rest.
Yet, some major groups that were lined up against previous reform efforts -- most notably the pharmaceutical industry and organized medicine -- are now advertising their support. Despite the bad press over the haranguing and arguing, there has been much more engagement, much more deal making and number crunching. Making a business case, not just an emotional one, may be the winning formula this time around.
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