One other observation about the healthcare reform moment we're in: yesterday's developments, which played out fairly fast and furious (by the time I finished my post, it was clear the Medicaid piece of expansion to 150% was actually DOA), reminded me of another problem we have, that there's precious little good blogging going on around healthcare, reform, and understanding more fully what is and isn't happening.
I've worked this observation from the reverse angle of saying we don't have a good, informative conversation about healthcare in this country... but it's important to understand why that is, and why it's hard to undo. I think a couple of things are in play: one is that, for a number of reasons, healthcare professionals, especially doctors but really a wide swath of the professions, are not online in quite the way others are (like writers, lawyers, educators, etc). This is part of the big hurdle to computerizing and standardizing medical records, in that even now, most doctors use paper for medical notes, and train their support personnel in similar methods. Ever notice that your doc's office has a huge collection of paper files? Ever notice that it's growing and not shrinking? That's the medical records problem... and it's enormous.
And it's indicative of how little daily interaction medical professionals have online; it's just not folded into the daily rhythm of many offices, care centers, or hospitals. Sure, there are exceptions... but many of them underscore that same divide: the medical professionals who do blog tend to be outside of practice (docs who write columns, do TV reporting, write books, and such). Some are working in nonprofits and other groups and are, indeed, working on reforms... but the point is, those people are outside of the practicing mainstream, and their views reflect, often, a narrow subset of the full professional insight on reform and its impact on actual care.
Feeding that narrow range of views is the fact, as I've pointed out before, that much of the energy around reform and thinking ceatively about changing healthcare is happening among liberlas and progressives. There is little activity on health reform on the right - a symptom and an illustration of the conservative malaise right now that there is so little interest in such a key issue - and the lack of knowledgeable opposing views hinders broad, thoughtful debate. Too often, you get panels and discussions among people who all agree, who share very similar backgrounds, exposure to similar data and ideas, and who see solutions in much the same way. It's hard, for many people in the think of things, to understand that there's things that they're missing, important, valuable things that might challenge worldviews and easy conclusions.
And finally, as healthcare reform has moved to the center of political discussions and gained media attention, what's become clear is how many people either don't understand or are only recently getting up to speed on the healthcare systems in this country, and tend to repeat the word of others when caught uninformed, or less than fully aware. I have little or no use for bloggers - many prominent ones - who blog about healthcare by repeating snips of coverage, usually from Ezra Klein and/or Jon Cohn. Both men are doing good (though not great) work covering the day-to-day twists and turns in Congress... but both have limitations and biases that tend to get lost in repetition. And few bloggers are doing, or seem to want to do, the hard work of questing further for more information, or looking deeper at prevailing views to ask if they make sense, or are supported by all the data. Hence, the need for a public option - which should have been a small piece of a number of other, much more significant changes to insurance - became by repetition and general agreement and lack of investigation... a be-all, end-all political chip that distorted the whole debate.
In the end, all of this reminds me that I ought to do more to write about these things, because I do have information to share, insights to challenge the status quo, and the ability to write persuasively. And I don;'t mean to leave anyone high and dry when it comes to looking for other, alternative places for insight. Myself, I'f recommend these in relative order of insight, usefulness and alternative ideas:
- The Healthcare blog - where you will find medical professionals with a variety of experiences sharing a broad range of ideas
- Karen Tumulty - who's been doing some of the best straight reporting I've seen that is both thorough and informative
- Talk Left - where Big Tent Democrat doesn't buy into all the hype of the progressives
- The Daily Dose at Washington Post - the Wa Po's more through (and more thoroughly reported) blog on healthcare, which makes you wonder why they need Ezra separately.
- Firedoglake - not my favorite site, but Jane Hamsher and company are very up to speed on both the politics and a number of the larger issues
- The Prescriptions blog at the New York Times, which occasionally breaks new news, and can be very insightful (but can also be very much the voice of The Establishment, as the Times likes to do)
- The healthcare blog at Change.org - a little likely to rehash the same Ezra Klein/Jon Cohn boilerplate, but with lively discussion threads. For that matter, if you do read Ezra, I highly recommend following his comment threads; a number of his commenters are very good for pointing out the weaknesses in his arguments, theories and political stances.
As I find more, I'll pass them along. I'm always on the lookout, and I appreciate any others you can share.
Still, the lack of anything but repetition of the same ideas, the same political thinking, and the same laundry list of expectations is tiring. As long as healthcare reform is a narrow conversation, among (fairly) informed people with similar poltical and worldviews who reach the same if not similar conclusions... we're not likely to have the good, healthy discussion we need... the one which, I think, would have made the current bill in Congress either a dead issue, or a significantly different, better piece of legislation than it is shaping up to be. The prmoise of blogs is that they offer the potential to challenge the status quo and offer fresh ideas; the challenge is that to do that requires the different thinking, different voices and fresh ideas of outsiders. And we don't have that... instead we have silence. And repetition.
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