Why do you suppose there continues to be so much dissension about healthcare reform, Reform 2.0?

I think it is because Congress failed to acknowledge that ninety-eight percent of healthcare is local; Hyperlocal.  What is hyperlocal?  You know the saying, “All politics are local?”  Well, hyperlocal is local on steroids.  It is moms and dads making choices about who will care for their family.  It’s the doctor down the street, not the doctor chosen by some system.

Individuals on both sides of the aisle, those in favor and those opposed to reform, view healthcare reform and ask “What’s in it for me” and “What will reform do to me?”  The dissension comes from those who have healthcare.  Nobody who does not have healthcare is complaining about reform because no matter what happens they should be better off than they were.

For healthcare reform to work it must meet the test of meCare, it must be viewed as improving my healthcare.  Nobody who has healthcare views reform as meCare.  They view reform as themCare—what’s in it for them.  That is why so many continue to be against reform.  In a zero sum game, somebody with something has to give up something in order for those without something to get something.  The general perception of those with healthcare is that for someone else to be better off they must be made worse off.

What has people talking about trying to kill reform is that nobody who currently has healthcare believes they will see any net gain from reform—they will see a net loss.  If any benefit will accrue to those who presently have healthcare, nobody has articulated the benefit.

To gain support for Reform 2.0, or whatever it comes to be called, those doing the reforming need to dust off their English 101 textbooks and turn to the section on pronouns.  I was a math major, so you may not to take the following at face value, but here it comes.

The most important thing to understand about who supports healthcare reform and to understand why people are in one camp or the other is for the reformers to understand pronouns.

At the end of the movie The Field of Dreams Shoeless Joe Jackson asked Terence Mann to follow him through the cornfield.  Ray Kinsella is upset because Shoeless Joe did not invite him.

Ray Kinsella: I did it all. I listened to the voices, I did what they told me, and not once did I ask what’s in it for me?

Shoeless Joe Jackson: What are you saying Ray?

Ray Kinsella: I’m saying…what’s in it for me?

And therein lays the rub.  That is the question people are asking, governors are asking, and attorneys general are asking.

For reform to work it must incorporate first person interests, not just second or third.  Does that sound selfish?  I do not have a dog in this hunt, and that is probably because I have healthcare.  I do however—and this is going to kill my neo-conservative club membership—think that people who are sick, whether they have green hair and are in this country illegally, have the right, just because they are people—which should be the only criteria for admission—to be treated.

I will pause for a moment as my loyal readers take a few minutes to unsubscribe from my blog.

For reform to work, Congress must learn to conjugate the care verb: First person—iCare, meCare Second and third person—heCare, sheCare, theyCare, youCare. That about covers all the various forms of caring.

What continues to ruffle a lot of feathers is that there is no meCare in heCare, sheCare, or theyCare—hence, the dissension.

The battle over pronouns will continue to show itself as ACOs roll out and as population health gains a foothold.  When it comes to patient experience the only pronoun that matters is meCare, and anything that lessens that will not succeed.

What do you think?