While The Radical Center: The Future of American Politics in its broad perspective may seem outside the usual scope of this column at first glance, it is an important book that does address healthcare as one area of American life in need of dramatic overhaul.
Authors Halstead and Lind, who are affiliated with the New America Foundation, a think tank in Washington, D.C., discuss healthcare as a socioeconomic issue whose delivery will continue to be inextricably intertwined with the political reality of the day. They posit that currently there is a crisis in how the United States is organized and managed, and that dramatic, new solutions are essential to solving problems in the future.
America at Its Third Turning Point
The authors provide context for what Newsweek called their “fresh and intelligent roadmap for America’s future” with a brief history lesson. On two occasions in our history America has dramatically reconfigured itself. First the country shifted from an agrarian to an industrial society after the Civil War. Then it successfully adapted to the massive technological and demographic changes of the early 20th century during the New Deal era. Now, they propose, we face the third turning point and must reinvent America once again.
They discuss the convergence of political and technological currents that underlie the need for America’s reinvention. The liberalism of the 1960s and the conservatism of the 1980s have passed and most people in the United States consider themselves centrists and moderates: hence the term “the radical center.” Thanks to the Information Age our citizens in general are more sophisticated and capable of handling greater choices and responsibilities. But at the same time our nation has ignored incredible technical advances that could be used to create a modern system that responds to the wishes of our people.
Further, Halstead and Lind note that with each election a smaller percentage of citizens vote. At the time of the 2000 elections less than one half of our citizens belonged to a political party. More people identified themselves as Independents than as either Republicans or Democrats. Our current president lost the popular vote but won the election.
They present significant evidence to show how institutions that served us in the past are not working in the 21st century. Their assessment includes criticism of a social contract that provides no flexibility or security and of schools and communities that fail to impart the skills and values our citizens need.
These authors not only document problems, they propose solutions. They demand reforms in how we organize elections, provide healthcare and retirement security, collect taxes, structure employment, enforce civil rights, and educate our children.
Radical Proposals Stimulate Thought
They suggest simplistic, radical alternatives to some social programs, such as providing each child a one-time gift of $6,000 at birth for the family to invest within strict guidelines. This would cost only $24 billion per year and could replace college loan programs and even social security.
What do they have to say specifically about healthcare? They see “the design of America’s health system as an accident of history.” The book proposes a citizen-based approach to universal, portable health insurance. They project a federally mandated self-insurance system with a public health insurance safety net for the genuinely needy. This mandated health insurance would have a bare-bones benefit package and then those who could afford it would purchase additional coverage for “luxury” health insurance (to cover such things as neurosurgery).
Beyond health insurance, they predict that our historical racial divide and present generational divide will be replaced in the future by a genetic divide. The elite will be able to afford genetic engineering not available to most people.
This book does not have all of the answers butt it raises wonderfully stimulating questions that help us think about our present crisis, as well as what might be done about it. Read it.
On the subject of books with a socioeconomic focus, read another current hot book called The Lost Art of Drawing the Line: How Fairness Went Too Far by Philip K. Howard (Random House, 2001, New York, pp. 255). It’s a wonderful book that provides a sometimes humorous look at the litigious nature of our society and its unforeseen effects.
Gary VanderArk, MD, is a member of the AANS Board of Directors, a senior partner of Rocky Mountain Neurosurgical Alliance, Englewood, Colo., and past president of the Colorado Medical Society. He is the recipient of the 2001 AANS Humanitarian Award.