Politics and public health clash in final reform debates

As anyone could have predicted, reform has resulted in some bitter battles over what the U.S. health system should become. Unfortunately, the interest groups involved aren't working from the same playbook, and the clash between medicine and political calculation has never been starker.

On the one hand, you have politicians, who are working to satisfy as many stakeholders as possible. On the other, you have public health and medical experts, who rely on observation and science to draw conclusions, but may give too little thought as to what flies in Dubuque. Unfortunately, the two are on a collision course in this debate.

In some cases, what works politically doesn't make public health sense. For example, while some politicians work to satisfy voters who want to set as many barriers to illegal-immigrant coverage as possible, public health logic dictates that as many U.S. residents as possible get at least key services. While your aunt in Cleveland may not care about herd immunity, public health experts must. This is the kind of debate that rarely ends well.

What's more, members of Congress must be ready to change positions quickly if the political climate changes. Science, on the other hand, dictates that clinicians and public health officials work from available evidence. Even the most informed member of Congress may bend on issues like, say, coverage of mental health if the popular will hasn't caught up to the evidence regarding the cost benefits of adequate treatment. Nobody from the mental health research or practice communities is going to let this issue go.

Of course, this clash between politics and practice is not confined to healthcare. In fact, you can see the same dynamic play out in discussions of many other issues, including environmental, educational and criminal justice problems. But the contrast between political sentiment and scientific priorities is especially evident here.

I wish I could say I saw a solution to the problem, but unfortunately, it's ingrained in our system of government. That being said, I can encourage everyone who reads this to be an advocate for the changes they think will serve patients. Yeah, that's a bit of a platitude, but at this point, that's what we've got. - Anne [1]