Nelb: Organize for health-care reform

Like millions of Americans across the country, I found myself on the National Mall for President Barack Obama’s inauguration last Tuesday. It was cold, it was crowded, and I could hardly see anything, but still I was inspired.

If millions of average citizens from all walks of life can come together for a day to unite around a common cause, what else can we do? As many have said, now is time for Obama to get to work, but the question of how exactly he should govern remains. Some want Obama to take decisive action to reverse the policies of the Bush Administration, while others hope he will work with Republicans in a new spirit of post-partisanship. I, for one, am thinking about those of us in the back of the crowd, hoping that Obama will find a meaningful way to listen to our voices as he confronts our nation’s major policy challenges, like health-care reform.

Indeed, the fact is that despite all the rhetoric of hope and change, the art of policy making is still just as messy as always. In health care especially, interest groups like insurance companies, hospitals and doctors continue to spend millions of dollars to protect their profits while the rest of us hardly have enough money to pay our medical bills.

To break this fundamental disconnect between the people making policy and those affected by it, Obama’s transition team pioneered several new models of interactive citizen engagement. Most notably, the transition team used its Web site, Change.gov, to organize thousands of community health care discussions across the country. It was just a beginning, but it was a good start.

Now that the transition is over, however, the challenge for the new administration will be to turn all these ideas and all this energy into policies that work and people who mobilize for substantive policy changes. This task will not be easy.

Inevitably, the ideas submitted through community forums will not agree, and some may not even be feasible. Nevertheless, if we believe in the power of democracy, then we can only hope that everyone’s individual perspectives will somehow coalesce into a greater whole and that an open and inclusive process will encourage even those who disagree to stay involved in the fight for reform.

As the new administration considers various options for civic engagement, our home state of Connecticut can serve as a valuable case study. This past year, the Connecticut Health First Authority, a new commission established by the state to compile recommendations for health reform, held a series of public hearings across the state. Hundreds of residents participated in the hearings, but like many commissions, the process of developing recommendations has been slowed, and the committee was only able to put out a draft report by its end-of-year deadline. The report itself contains detailed policy analyses and recommendations, but, at the end of the day, I bet only a few policy wonks have even read it.

In contrast, the Universal Health Care Foundation of Connecticut has been not only soliciting ideas from community members but also engaging and organizing diverse groups to come together for reform. As a result, their new health reform proposal, Sustinet, attracted hundreds of supporters at its launch in Hartford earlier this month, including groups like the Connecticut State Medical Society, which have often resisted attempts at reform. The structure of the plan is somewhat similar to what was proposed by the Connecticut Health First Authority, but SustiNet will likely gain more traction in the state house because they have a true grassroots network of support. The secret for meaningful community engagement, it seems, is not relegating community input in the comment box, but rather engaging people to get up on the soapbox and make their voices heard.

I am optimistic about the potential of this type of community action, but for many policy elites in Washington (Yalies included), it is easy to be skeptical. We think we already know what policies are best to pursue, we think the average citizen can’t understand the technical details of policies like health reform, and we think the president and Congress are the only decision-makers that matter.

So, when I stood in the cold in the back of the crowd on Tuesday, I was impressed with Yale poet Elizabeth Alexander, who took the focus from Obama for a few minutes to speak about the rest of us and our daily challenges: “Praise song for struggle; praise song for the day. Praise song for every hand-lettered sign; the figuring it out at kitchen tables.”

In the debates to come, few will talk about the hand-lettered signs of community activists or the kitchen table discussions of the average American, but in the end, they are the engines of our democracy. Indeed, in order to achieve true progress, the new administration as well as each and every one of us must first truly listen to our fellow citizens.

Robert Nelb is a first-year student at the School of Public Health and a 2008 graduate of Timothy Dwight College.

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