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Battle over health-care reform: vital lessons from America's founding fathers

Despite the ongoing attempts of House Republicans to kill President Obama's health-care reform law, the history of America's intense debate over ratifying the Constitution should make us optimistic about the law being accepted, improved, and implemented.

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And what did implacable opponents, like Patrick Henry and George Mason, provide as their part? First, they acknowledged that there was a serious problem to be solved (the Articles of Confederation were inadequate), and they agreed to have an honest and fair debate. They did not reject the process, continually suggested amendments, and did not label the majority un-American. Some skeptics had the courage to admit, as state conventions came to their closures, that most of their initial fears had been overcome by the logic and facts and the respectful nature of the pro-constitution debaters. Fears are easily exaggerated by emotion fueled on partisan distrust. Supporters also admitted the skeptics had many good points, which improved the final product. On the whole there was a great deal more intellectual honesty and mutual respect than we’ve seen in the past two (10? 20?) years in Washington.

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Reasons for optimism

So why does this history make me more optimistic about health reform being accepted, improved, and implemented?

Because our debate is now moving to the states, where many leaders who are closer to real people’s lives – people who want better health-care choices – know and admit the status quo is unsatisfactory and unsustainable.

Because I know many clinician leaders see how the tools of the new law can help them deliver higher quality care more efficiently and humanely. Because the “amendments” that would reduce opponents’ fears actually do make sense – for example, malpractice reform, more state flexibility in how to re-organize Medicaid and insurance markets, plus stronger budget protections if the savings from delivery system reform provisions do not materialize.

And because I know most Democrats and the president are willing to engage in honest debate about amendments and improvements. The question is, now that they’ve kept their campaign promise to their excitable base, are Republicans in Congress more interested in focusing on what matters most, actually solving our health-care problems, or in polarizing politics? Will the pragmatic preferences of independent voters push them to rise to the level of the 18th century statesmen they claim to admire? I choose to believe, when push comes to shove, the best interests of our country will once again become self-evident and govern the choices of the people’s representatives.

Len M. Nichols is director of the Center for Health Policy Research and Ethics at George Mason University.


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