If our country is serious about healthcare reform, it behooves us to ask:
Wherever there is a misalignment between these Ought To's and the Can Be's (i.e., when we can't do what we ought to be doing), it is wise to ask: WHAT'S PREVENTING US and HOW CAN WE overcome those obstacles?
Unfortunately, when it comes to healthcare, other domestic issues, and even foreign policy, answering these questions isn't easy because it requires that we stop deceiving ourselves, and start critically and objectively evaluating the values, priorities, goals, and underlying beliefs of our culture.
For example, let's say we agree that we ought to have access to high-quality healthcare we all can afford. And let's assume that high quality, highly efficiency universal healthcare isn't possible because of government budget deficiencies. Since this scenario would mean a continuation of our healthcare system's poor quality, high cost, and access inequity, we should be asking questions such as:
While the knowledge we would gain from answering these questions would direct us in developing solutions to the healthcare crisis, many (most?) people would react to all this by saying: "Be realistic! You can't change these things; it's just too difficult. We can't do what we ought to do because there are too many obstacles, so don't waste your time trying!
I disagree! We simply cannot afford such a defeatist view. We can gain a great deal by "looking at ourselves in the mirror." We'd be wise to ask the tough questions and not shy away from the radical transformation of our healthcare system and national priorities. It would be wise to do this with other domestic and international problems, as well.
Consider, for example, the recent interview of Andrew J. Bacevich on the Bill Moyer's Journal. Mr. Bacevich is an author, professor of international relations and history at Boston University, and retired Army colonel. He focused on the relationship between failed U.S. foreign policies and American consumerism. He concluded that our country's biggest problems are internal and the solution requires looking at ourselves in the mirror and asking the tough questions. Here are some quotes:
So, the U.S. is an empire of consumption relying on credit and military might to feed our materialistic addiction, as we indulge ourselves recklessly and squander our wealth and power with little regard for the common good. Instead of examining ourselves in the mirror and asking the tough questions about what we've become, we foolishly focus beyond our borders to fix the problems that are actually caused by our internal attitudes and systems.
This brings up a few final questions:
The following is an update added on 9/9/08:
Conversations I've been having subsequent to the original post--with with Phil Wray and John Milligan--have offered several useful ideas.
One is to think of aligning the Ought-To’s with the Can-Do’s as a dynamic process, as opposed to a static process, especially when there’s a potential “show stopper” obstacle (i.e., there is no way to achieve our Ought-To goals). This means that when we are prevented from doing everything we Ought-To be doing, the odds are that we can still do some of the things we Ought-To do. Those actions, and the knowledge we gain the process, can, in turn, “open new doors” that enable us to achieve more of the Ought-To’s by, for example, trying different tactics than originally considered, and/or by refining our definition of the original Ought-To’s within reason. In other words, by evolving our vision (goals & objectives) and methods (strategies & tactics) in light of the current realities, but without abandoning our initial intent, we can move ever closer to achieving our mission even when confronted with powerful obstacles.