A new kind of politics
Wednesday, August 26 2009
Dr. Wes waxes optimistic on the state of American politics:
With the deeply personal debate on health care and its associated reform costs, our need for honesty and successful policy to save our country is suddenly more important to us than the comfort of bedtime stories. This is political maturity.
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We are now (as voters) in a position to demand that legislation (including I daresay health-care reform) occur in incremental, transparent, understandable terms that voting citizens can vet themselves. Not thousands of pages of nearly incomprehensible gobbledygook.
The reason we are in this position, says Dr. Wes, “is transparency because of the internet”. Yes, the Internet: source of so much that is honest and transparent in this debate. The fact is that most people support health care reform, when they understand what is involved. What’s driving the opposition is mostly a bogus caricature they read about largely on the Internet – a caricature Dr. Wes has abetted.
This isn’t to deny the Internet’s potential for change. But that change might not be as beneficial as Dr. Wes thinks. Bear in mind that the same process is occurring in medicine: millions of patients are now turning to the Internet for information about their illnesses. Does Dr. Wes think the information online is better or worse than what a doctor might provide? And why would information about government and politics be any better?
My guess is the Internet will change medicine sooner than government. I can decide, on a day-to-day basis, whether I want to go online or go to a doctor. For better or worse, a single voter – even a majority of voters – can’t change the Constitution. And contrary to Dr. Wes’s assertions, our founders specifically denied voters the capacity to ‘vet’ legislation: they created a whole branch of government, the judiciary, to do so instead. So Congress doesn’t and won’t write laws for voters; it writes them for the lawyers and judges who figure out what laws mean.
Thus, what Dr. Wes calls ‘thousands of pages of gobbledygook’ is in fact 1018 pages designed to convey the intent of Congress as accurately as possible. Consider that the Americans with Disabilities Act, for example, was steadily diminished in its protections by questions over the meaning of one phrase – “major life activity” – so much that Congress had to pass a second law, ADA Restoration, reaffirming its original meaning. Or that proper interpretation of the Second Amendment – the right to bear arms – depends entirely on two commas. Love it or hate it, that’s our Constitution. Can an ordinary citizen make sense of it? Perhaps not. But can an ordinary citizen make sense of a medical journal article? Just because it’s ‘gobbledygook’ doesn’t mean it’s not purposeful and important.
Granted, I think our government will adapt, sooner or later. The machinery of our governance is based on 18th century technology; small wonder it has difficulty operating in the Information Age. Eventually, the divergence between government and society will have to be reconciled, but who knows how that process will unfold? Consider that California is right now in the throes of a crisis generated by too much direct participation by voters. Do we want that for the nation as a whole?
But just as government will change, so will medicine. Too many physicians adopt an archaic mindset that regards their patients as subordinates and supplicants. In fact, Dr. Wes argued at Putting Patients First that physicians should tell their patients to oppose health care reform – as if patients were theirs to boss around. This is a pre-Internet mindset.
For lots of patients, the Internet has been liberating. It connects us with other patients and resources, as well as information that helps us understand our diseases. No longer is the doctor the only or even principal source of information. Some of that information is bogus, some is invaluable – but right or wrong, access to that information puts patients in a position to demand that physicians talk to us in transparent, understandable terms, with treatments we can vet ourselves. Anything short of that is unacceptable.
To appropriate Dr. Wes’s rhetoric, it’s time for a new kind of medicine. I think – I hope – health care reform will help bring about that new kind of medicine. Dr. Wes is arguing against it, because he prefers the old kind of medicine. But this is the Internet: you are free to make up your own mind.
