The little engine that could
In the iconic tale "The Little Engine that Could," a disabled train needs a forceful push through rough terrain and onto its final destination. It inquires of the larger, more equipped and powerful engines but they all refuse. It is not until a small blue engine volunteers and dares the impossible, does the stranded train ascend the mountain and arrive at its promised end.
Faced with a more daunting task, we've entered a new year and a new decade. Not only do we have the chance to be reflective, but also to be forward thinking and deliberately hopeful. Typically, around this time we find ourselves in a "can do" fury and fleeting resolutions abound. What we need is not a spurt of momentum, but an impassioned push and the steely resolve to win at a Herculean feat.
The little blue engine succeeded at something that others confessed could not be done or risked too much. And it did so while repeating the famed affirmation, "I think I can. I think I can."
What is it that we think we can do? While the health-care debate has dragged on for a year, it is unclear whether the objective is to transform the health-care landscape or to initiate change and achieve a down payment on meaningful reform. Frankly, reform does not culminate in any legislation's passage. Rather, reform only begins. While no one should be the enemy of incremental progress, we must realistically frame short-term and long-term goals, which has yet to be done.
The "summer of discontent" crippled the health reform agenda. With latent hostilities made painfully apparent, the message was hijacked and health-care legislation became less about securing a better health covenant and more about salvaging political wins in a frayed and contentious atmosphere.
With political proselytizing at an epic frenzy, the perceived winners and losers have selfishly sidelined the interests of the American consumer and a weary public has grown suspicious and reluctant. Still, inaction is a reckless alternative for the millions suffocating under the status quo. Access and cost, the two hot button issues, have made for strange bedfellows in the health-care debate. Both are worthy causes, and in light of recent economic woes, both are crucial to the conversation, but good legislation hinges on a compelling mix of good policy and good politics, and these two have been cast as opposing corners in the ring.
True and radical change will surface when we confront the care culture where health promotion, wellness and prevention take a back seat to cure and disease management. In that far-away utopia, not quite in our immediate grasp, cure and care should receive equal billing and likewise creative strategies and dollars should be aimed at making health and well-being a more cogent issue for the masses.
Thus the more truthful question is do we think we can challenge that cultural behemoth. And to that, I say I know we can. But we must be willing to enlist in what is likely to be an uncomfortable battle, and a marathon indeed. So kudos to the landmark legislation, which is likely to pass the Congress but in retort, "now what?" With whatever health-care bill emerges from conference, imperfect at best, we simply live to fight another day.
And to that fight we must invite all stakeholders -- patients, families, caregivers, physicians, nurses, private industry, public health, clinical and research scholars, social and political scientists and all big thinkers who honestly believe in the can-do spirit.