You’ve heard the phrase: “Don’t make the perfect the enemy of the good” or its many derivatives? For some reason, this has become a much uttered, nearly cliché saying of late… the idea being that you should not allow the pursuit of perfection to prevent you from getting something, anything, reasonably worthwhile done.
I tend to agree as long as you don’t bend and break your core values. I believe that taking the time or expending the energy to make something that much better is often just not worth it in terms of a materially improving outcomes; the earlier in life you learn how to weigh up the pros and cons of something, the better off you are as we all spend a great deal of time considering tradeoffs and making decisions within murky shades of gray. I remember many years ago when churning over a difficult decision, my mother stated: “well, if it was easy, they would train a monkey to do it.” Such is life in the professional world. If it was easy to be a pharmacist, computers would be deployed instead. If it was easy to be a doctor, you could seek lesser trained (and lower cost and more accessible) paraprofessionals instead. And if you could easily pick which issues to support as a US Senator or Rep, then they would train a monkey to do it instead.
As readers here will know, I support the passage of a comprehensive health care reform bill. Providing coverage for the presently un- and underinsured population is the right thing to do (oh, and it’s the cost effective thing to do too). Moving toward payment reform is good. Instituting needed insurance reform is good. Shifting payments for providers to quality-based methodologies is good. All good.
And so last night at a gathering with friends, an unexpected and heated debate emerged regarding the current health reform debate. When asked point blank whether I support THIS reform package, I hesitated. Then, I said “no”. My friend, sensing triumph, exclaimed: “Read Your Blog!”… clearly suggesting that I’ve been a big supporter here.
I’ve been thinking about this all day. It’s not as though we have ONE UNIFIED package to assess at this point as that’s what the House and Senate are working on creating… and there are critical differences between the two versions. But there’s enough in common that we can pretty easily determine where the one final package will probably end up. As I’ve stated here before, the debate has been long on insurance reform and short on any other kind of reform. Furthermore, it has emphasized improving coverage and deemphasized how we’re ultimately going to pay for it all in the short-term, i.e., before the longer-term financial benefits begin to accrue. Similarly, estimates of morbidity and mortality don’t consider the fact that we’re all going to live longer, and need more services, than prior generations. And so, it’s flawed. In some ways, significantly so. It’s not perfect… far from it and I was thinking of these things when the no welled up within me.
So, do we go back to the drawing board? Do we crumple up the paper the two bills are written on and toss them into the wastebasket in the corner of our office and then start all over? Do we make the perfect the enemy of the good?
I don’t think so.
And so, I respectfully reverse my barroom position of last evening and state that I do support the passage of the reform bill. But, I have a caveat: If the final bill does come together and strays too far in a direction I don’t support, I’d like to have an opportunity to reverse myself… again.
Interested in your comments. Thanks.