I was a member of Lipscomb University’s debate team years ago. I recall the decks of evidence-cards we carried from tournament to tournament and propositions that ranged widely i.e. in 1970-71 “RESOLVED: “That the federal government should adopt a program of compulsory wage and price controls.” Before each round, the judge would designate an affirmative team and negative team and an orderly debate on the proposition would proceed. The judge would declare a winner based on the strength of arguments presented, the evidentiary support applied and how each side addressed challenges to their position. Then, in the next round we’d argue the opposite side of the same proposition per the rules of intercollegiate debate. Our goal was to win the debate and advance to the National Debate Tournament. The more important aim was to structure dialogue on a complex issue featuring evidence, reasoning ultimately reaching consensus on the proposition.
As the New York Times noted (June 20, 1971):
“…the college debaters tend to be individuals who hold the corporation in little esteem and are not particularly inclined to see things the way business does. Nor do they have any particular sympathy for unions, most of which, they feel, are standing in the way of progress for blacks and of other causes in which they believe.
It is all the more striking, therefore, that this year’s college debaters overwhelmingly concluded that the idea of imposing price and wage controls simply cannot be rationally defended.
History and economics combined led the debaters to their conclusion.
One of the crucial things they found was that events under price controls completely validated the economic theory that holding prices below those a free market would set inevitably created shortages—and black markets. In economic theory, the price set by the free market is the price that will balance supply and demand; any other price will create an imbalance. The college debaters ultimately came to wonder why anyone thought the American people would put up with shortages and black markets during the most unpopular war the nation has ever fought.”
Like most, I was stunned by Charlie Kirk’s murder. Quickly, media coverage reminded viewers that violence is recurring in American politics these days: in June, Minnesota state Rep. Melissa Hortman, a Democrat, and her husband killed by an assailant who entered their home; in May, Israeli embassy staffers Yaron Lischinsky and Sarah Lynn Milgrim gunned down while leaving an event at the Capital Jewish Museum in D.C. , in April, an arsonist set fire to the residence of Josh Shapiro, Pennsylvania’s Democratic governor, while his family was inside.
In our society, emotional and economic anxiety is at its peak. Opinions are sharply divided on major issues and self-serving flame throwers exploit these tensions to fuel fires.
Healthcare is no exception. The murder of UnitedHealth Group executive Brian Thompson was a reminder. People feel strongly about issues and institutions these days. Our industry’s business practices and institutions evoke strong emotion. Misinformation is high and the public’s understanding of the system is low. How it’s structured, funded, regulated and operated is unknown to the majority who depend on personal experiences and media coverage as their surrogate sources.
What’s evolved over the last 20 years of coalitions that align with contrasting views….
- RIGHT VS. PRIVILEGE: Those who believe access (insurance) to the health system is a right that should be funded by the government vs. an individual choice is in a free market economy.
- PROVIDERS VS. PAYERS: Those who provide healthcare services—hospitals, physicians, long-term care providers—who deliver services vs. insurers who serve as intermediaries to arbitrate quality and payments.
- EMPLOYERS THAT PROVIDE COVERAGE VS. THOSE THAT DON’T: Those companies and organizations that provide health benefits to their employees and dependents enabling margins to providers vs. companies that don’t.
- DRUG MAKERS VS. MIDDLEMEN: Those who produce and distribute drugs that treat conditions and save lives under government protections vs. individuals who pay for their products.
- RED STATE HEALTHCARE VS. BLUE STATE HEALTHCARE: Those states that facilitate access to Medicaid and social services programs for their citizens vs. those that don’t due to costs.
- PUBLIC HEALTH VS. PRIVATE DELIVERY SYSTEMS: Those providers who serve lower-income or disadvantaged populations through public health programs vs. those who served insured populations.
- TRADITIONAL MEDICAL ESTABLISHMENT VS. NEW ENTRANTS: behavioral, dental and nutritional health professionals seeking integration in care delivery and financing vs. the status quo.
And many others. The public’s somewhat aware but increasingly held hostage by echo chambers that reinforce their views and discount others.
The status quo in healthcare is Darwinian: survival means defending turf against all others i.e. hospitals vs. insurers, primary care vs. specialty, public health vs. local delivery systems, drug companies vs. pharmacy benefits managers, alternative (non-western) medicine vs. allopathic medicine, et al. In many cases, these fights feature corporate heavyweights fending for shareholder expectations and not-for-profit operators who extract eye-popping profits and compensate executives handsomely. And these fights have devolved in each sector to winning and losing based on size, locations and alliances. And these fights provoke violence.
It’s time to re-think the industry’s future with the public’s wellbeing its only purpose. Sectarian war games have served their purpose but at a cost that’s unsustainable. A national debate akin to the collegiate debate should consider the following proposition:
Resolved: the U.S. health system should be fundamentally transformed to prioritize sustainability, accessibility, affordability and the health and wellbeing of the entire population.
Affirmative argument: the health system is effectively transforming itself to address these aims already. Transformation is succeeding.
Negative argument: the health system is unable and/or unlikely to transform itself due to structural, regulatory and economic constraints. Transformation is failing and a new direction necessary.
Charlie Kirk’s forte’ was public debate—face to face encounters with individuals of differing views wherein decorum and mutual respect are maintained and opposing views heard. We need a series of these debates in healthcare to get past posturing and seek answers. Most trade associations argue on behalf of their members. Most elected officials argue on behalf of their donors and voters. Most healthcare think-tanks and NGO’s focus on pieces of the healthcare puzzle their sponsors choose using talking heads and supportive studies to advance their views. They’re not solving system issues; they’re protecting themselves.
As I travel, I listen to Boards that are concerned and CEOs who are stretched thin. They acknowledge the future of the system is not a repeat of its past, but uncertainty about what the future holds. They focus on short-term financial results while acknowledging the need to do more.
I believe the health system is fundamentally flawed and unsustainable. It’s not about bad people; it’s about systemic flaws.
The platform for transformational change in healthcare has not been built. It’s more rhetoric than reality.
The legacy of Charlie Kirk in healthcare should be our willingness to host debates about its future and turn off the blame and shame game to which it’s addicted.
Which association or company will lead the charge? The National Collegiate Debate competition was spearheaded by Ford Motor Company dating back to 1947. It’s needed now more than ever.
Thanks for considering this.
Paul
