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In Defense Of Incrementalism

By Douglas Schoen

Given the health care crisis in America today, it is not at all surprising that there is strong support in public polling for a drastic overhaul of the system.

Many polls have shown strong support for universal health care and a single payer system. Those same polls, similarly show a stated willingness to pay higher taxes to achieve that goal. Based on that, many politicians--particularly those on the left--have been outspoken in support of fundamental change in our current system to encompass these goals.

How they seek to achieve that change is subject to significant debate and detailed policy discussion, the details of which are hard for most Americans to grasp. But it is taken almost as a given by most that unless the system is fundamentally altered, the will of the American people will not necessarily be done.
My own examination of public opinion suggests another view which is not necessarily adverse to this way of thinking. Rather it suggests that in the absence of immediate reform of the system, the American people eagerly embrace incremental initiatives to improve a system they believe is in dire need of alteration.

The American people have been clear in supporting bipartisan activities to improve the current system. They have also embraced collaborative efforts by business, labor, and consumers to work together to make health care more accessible and affordable.

What then are some of the initiatives large majorities of the American people would like to see implemented immediately, before wholesale overhaul of the system can be initiated?

First and foremost, the American people would like to see government health care benefits extended to all children without this protection as soon as possible. There is strong consensus among voters of both parties that this should be done immediately, by any means necessary.

Second, the American people applaud any efforts that reduce the price of prescription drugs--whether it be done legislatively or by nongovernmental action involving the drug companies, business, and labor. Voters do not necessarily think in policy terms. They link in terms of outputs and any policy that reduces the ultimate cost of drugs is a good thing--no matter how it is accomplished.

Third, the American people are clear that health insurance payments for mental health services should be reimbursed at similar levels to those for physical health care services. This is seen as a clear responsibility of our government, not something that should be subject to politics.

Fourth, the American people also endorse efforts to embrace prevention to avoid disease and support policies to accomplish this goal. They also have indicated that these efforts deserve more time, attention, and money from policymakers than they have received to date.

Fifth, they want to see issues like health care for an increasingly aging population addressed by government and business. We face new challenges and new diseases now that the population is living a longer time and they want to see industry, business, and government address this issue constructively and on a collaborative basis.

Health care as a matter of broad government policy will be endlessly debated as campaign 2008 proceeds. It would be a shame if these urgent challenges which have immediate, real world implications are not taken up as well.

Douglas E. Schoen is the author of the recently published book, The Power of the Vote: Electing Presidents, Overthrowing Dicators, and Promoting Democracy Around the World (Morrow, 2007).

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