What does it say about our current situation when the most useful analogy about public policy that I’ve seen in years comes from a horror movie?
“The Others,” a 2001 release starring Nicole Kidman, taps into deep personal and social anxieties. Sense of isolation? Check. Nicole and her children are nearly alone in a drafty manor home on the island of Jersey following the end of World War II. Fear for our families? Check. Her husband is MIA, and her children have an illness that makes them deathly ill from exposure to sunlight. Fear of others? Check. Strangers show up to help her, but can we trust them? Lack of control? Check.
Nicole’s character is paralyzed by fear and an inability to have any impact on the world around her. Scene by scene, the director slowly ratchets up the audience’s anxiety level as we wait for ghosts to suddenly appear from behind drawn curtains. The film’s entire artifice finally falls apart — and back into place — when we realize that Nicole and her family aren’t being haunted by ghosts; they are themselves the ghosts and are haunting the real-life family that occupies their former home. Nicole’s character couldn’t let go of her former reality, no matter how much her world had changed. And she couldn’t move on until she accepted her new reality.
It’s a brilliant movie — and an apt metaphor for why we need a new model for public policy in Minnesota, especially surrounding “health care” and “health reform.”
The ghosts of ‘health care’
The Citizens League’s past policy successes on health care were in part due to the fact that we could pull back the curtain, metaphorically, on important policy issues and show people what was really happening. Policy impact and success began with an honest conversation about the facts and their implications. Without the right definition of a problem, solutions are destined to fail.
One of the ghosts we have to confront is that our entire conversation about “health care” and “health reform” isn’t really about creating health. It’s about reforming insurance and the delivery of hospital and medical services.
This isn’t to say that medical system goals of access, quality and affordability aren’t critically important to improving the delivery of these medical services. Lack of access is ultimately unjust. We can significantly improve the value of our already high-quality medical services in Minnesota.
Most of the costs in our current system are wrapped up in five chronic conditions (diabetes, cancer, heart disease, stroke and Chronic Obstructive Pulmonary Disorder) and end-of-life care. Reforms in the delivery of medical services and insurance can improve the treatment and maintenance of these conditions — thereby bending the cost curve — but they can’t prevent or avoid these conditions. If we don’t reduce the need for these hospital medical services, we won’t have any money left for any other public good — from schools to parks to roads.
That’s scary. And unsustainable.
Reimagining health policy
The Citizens League is developing a new model for public policy that we call “civic policy making.” As we endeavored to apply this model to “health care,” we realized that, in addition to reforming medical and hospital services, we need to reimagine — and create — a new infrastructure for achieving health.
We have to redefine what we mean by “health.” Is it more than the absence or maintenance of disease? Luckily, dozens of conversations we’ve had throughout Minnesota, sponsored by the Bush Foundation and reporting to the bipartisan Health Reform Task Force, confirm that there is surprising agreement by the public (across partisan differences) on what we mean by “health.”
It involves an inherent sense of balance in our lives. Minnesotans agree that we have a role in co-producing our own health and an obligation to improve our health. How can health be the default opportunity in our daily lives, rather than something we have to go out of our way to achieve? What is the role of creating health within families, workplaces, neighborhoods and schools? Are we putting too much responsibility for this on medical service organizations and government?
Most of our resources are spent on 10% of the problem
As it turns out, the quality delivery of medical services accounts for approximately 10 percent of longevity gains and healthy aging. Environmental and social circumstances and individual choices affect 60 percent of these outcomes, and genetics are another 30 percent. We spend most of our time and resources on 10 percent of the problem.
This conversation is both new, with profound implications for all individuals and organizations, and one that the public wants to have. It’s also an example of why we need a new model for policy making that recognizes the roles we all have in achieving policy outcomes.
When it comes to imagining and creating new systems of health, we first must realize that “the others” aren’t someone else, somewhere else. They’re all of us. Only then will we be able to create the infrastructure for everyone, everywhere to achieve healthier outcomes. Only then will we have truly exorcised our health-care-reform ghosts.
Sean Kershaw is the executive director of the Citizens League. He can be reached at firstname.lastname@example.org, 651-289-1070, @seankershaw (Twitter), or Facebook.
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