The now-stalled U.S. Health Care reform effort shows that our elected officials lack the will and skill to exercise leadership in sacrifice.
To enact reform, politicians—people-pleasers and self-preservationists by trade, would, ironically, have to sacrifice themselves politically, and at the same time ask American voters to make sacrifices of their own. Supporting it means offending multiple constituencies and interests that fund elections, while simultaneously looking to the masses to give up the devil they know. Elected officials have done the math on that loser, which is what’s stalling progress and promoting endless media rehash.
- Publicly offer tremendous candor about the change and warts-and-all sacrifices being asked of many (.e.g., Kennedy: "We do these things not because they are easy, but because they are hard."), and;
- Offer such a vision and hope for a better future for all, that we deem the tradeoffs to be worthwhile.
Leadership in sacrifice requires self-sacrifice—it cannot coexist with an overriding drive for self-preservation. If a politician wants to get reelected, alienating constituencies and pushing uncomfortable change is hardly at the top of their list of things to do today.
Yet every possible set of health care reform proposals comes with sacrifices that create fearful, angered mobs of people. There’s no way to prevent these “negative constituencies,” who then take up arms and take out ads against the proposals and politicians supporting them. No dummies, these guys then remove their support and head for the hills. Meanwhile, we all continue to foot the bill for their cowardice in taxpayer dollars for emergency room primary care for the indigent, infinite deficits, and the tens of millions of uninsured and medically bankrupt people.
Leadership in sacrifice means a leader must stand up and do the unthinkable: tell the people exactly what they are giving up—how we will wait for procedures, how we may not get our first choice of doctor, etc., and in exchange for that, give us vision and hope for a future far better than the present.
Entitled Americans, myself included, must buy into the upside of the bother-to-benefit ratio; so much so that we willingly accept some perceived degradation and sacrifice for the good of all of us.
Negative constituencies will continue to be created, and to cry foul. Insurance companies, pharmaceutical companies, medical educators, researchers, and hospitals have to spend time and money redesigning themselves. Wealthy people will pay more taxes. Some ill people will have to wait for that MRI they need. Medical professionals may be paid differently than they are today. And the list of the likely displeased goes on.
Yet the payoff is that we are doing something to make our country a greater place for everyone—we will be helping our neighbors and pulling together in a way that we knew how to do, but have forgotten for many decades. It will make us a better, more resilient nation.
Most of us are already sacrificing a lot—high premiums, lower benefits, high drug costs, pre-existing condition exclusions, medical bankruptcies, and lower quality health care than most developed nations—so to be frank, we are simply trading one set of sacrifices for other, hopefully wiser ones.
That means we need to be given the vision and hope required to enlist us into a sense of a shared commitment, one that ensures every American gets some level of health care, and costs are manageable for all of us.
I challenge our leaders to ask us directly and honestly for such sacrifices, with full disclosure of the warts and all, and in context of the “many” doing a greater good for the “all.” Excite and seduce us with a truly better future, then get our support, and ask us to help make it happen. Know that we’ll complain, criticize, have our little entitlement fits, take out our nasty ads, and maybe thank the leaders that did the deed by NOT reelecting them, because things will suck for a while, and we’ll be pissed about it.
But in the end, we’re going to have a society in which we care for and about each other. That's a a gift that will give leaders something better than holding office again: tremendous satisfaction that they did something historically important, and great: the right thing for everyone.