Click here for a full text transcript of the conversation.

Host Ira Flatow said in his introduction:

“Lost in the fray [of acronyms and actuarial tables] is the whole reason to have the health care debate in the first place…we’re going to try to reel it back in to talk about our values. What role do they play in shaping health care policy?”

Flatow noted that in its recent collection of essays, Connecting American Values with Health Reform, “The Hastings Center has tried to bring values back into the discussion.”

Len Nichols, health policy director at the New America Foundation, also participated in the show. Nichols, a health economist who wrote an essay on stewardship for the Hastings Center collection, said that passage of the final health care reform legislation is contingent on leadership that promotes shared values. “It is sometimes true is that those values seem to differ among political antagonists….but when you probe deeply and get in a dialogue you find out the values are actually shared,” Nichols said. “I believe most people share them and therefore we will end up with a bill that moves our country forward.”

These are some of the American Values highlighted in the Hastings Center’s report on “Connecting American Values with Health Reform.”

Watching health reform unfold here in Washington, however, that “Connection” is painfully elusive.  The debate is not a careful calibration of competing rights, values and obligations. It’s a political moshpit. Instead of values, we have vitriol.

Outside of Washington, even extremely astute people ask me why we can’t fix a health care system that is inefficient, inequitable and  downright inexplicable.

I patiently explain that this fight is not purely about policy (or values). Health policy becomes a gritty proxy for politics.

Values,  or at least ideology – particularly about the size and reach of government – play a role in politics. But an awful lot of what passes for policy debate is trench warfare before the next election.  Look at the list of amendments proposed for any of the major bills – and ask yourself how many are meant to improve the health and well-being of the American people and the American economy, and how many are meant to score points, woo donors, placate interest groups and create a C-Span moment.(Both parties do this, particularly while in the minority; theatrics is the next best thing to votes.)

Still, for those who believe (as President Obama tells us)  in a moral imperative to cover the uninsured and create an economically sustainable health system, it is  tempting to indulge in a little values-imbued wishful thinking.

What would the health reform debate look like if, as Thomas Murray wrote in the introduction to the Hastings essays, values were the “beating heart of health reform?”  What if the health care debate truly was aimed at realizing our national vision of “liberty and justice for all”? What would it look like if we dropped that vitriol, and returned to values? If, as Dr. Murray wrote, we centered on this simple core idea:

Everyone should be responsible for participating in whatever way is appropriate. When anyone needs health care that is reasonably effective and not financially ruinous, the care will be there for them.

To have such a conversation, the first requirement would be honesty. I’m not sure if it’s Jeffersonian, Hamiltonian or Jacksonian but I certainly like to think of honesty as an American value.

If we were honest, we’d still have genuine and perhaps unbridgeable differences about the public plan, or the level of subsidies or the practicality of certain models of care.

But we wouldn’t be screaming about death panels, abortion mandates, illegal immigrants, taxpayer funded sex change operations and a government takeover of health care.

If we were honest, we would reach beyond bipartisan platitudes about a broken system and acknowledge that there is no such thing as the status quo in health care. Our system gets a bit more broken each day, and all sectors of society bear the cost in incalculable (and inequitable)  ways..

If we were honest, we would stop talking about “consumer” and “providers”  buying and selling goods and services in a rational market. We’d talk about patients and families and doctors and nurses, and understand that health care is not a “commodity” in the usual sense of the word.

Above all, we’d stop talking about how health reform is going to bring a scary heartless bureaucratically-induced rationing – and recognize that we are already rationing. Only we ration irrationally, in unkind, unfair and unscientific  ways. Our surest path to deeper and coarser rationing – the Medicare equivalent of slash and burn – is to do nothing.

That brings me to two of the final “Connecting Values” essays – Quality and Efficiency.  Both are concrete and pragmatic, less abstract than liberty or justice. But in health reform, they may be our salvation. We don’t, after all, have a Congressional Justice and Fairness Office “scoring” health legislation. We have a Congressional Budget Office – and budgets  may reflect our national values and priorites more than our shouted political discourse.

So rather than having two stark choices (taxing more or cutting benefits – aka rationing) we have a third path, that budgetary nirvana of delivery system reform, realigned payment incentives and comparative effectiveness research. New ways of delivering care, including a renewed emphasis on treating the frail and the chronically ill in the community instead of in the ER and ICU. New models of shared-decision making, and more and better palliative care, both of which may change how patients and families weigh when to reach for  the brass rings of modern medical technology, when to give chicken soup and Tylenol a try, when the time has come to seek a gentle end.

Maybe in 10 or 15 years from now, we’ll be back to shouting. Maybe these new models – accountable care organizations and multi-specialty physician group practices and advanced medical homes and  concurrent care – will  turn out to be one more set of next best things that weren’t so good after all. Maybe we are fooling ourselves when we listen to the quality and efficiency gurus who say we can have higher quality for lower cost. But I don’t think so. I’ve spend enough time talking to patients and clinicians at the forefront of change – from Annapolis to Akron to Anchorage — to believe that there is a better way. A way that will bring us quality and efficiency as well as justice and responsibility and compassion. If we can stop shouting long enough to get there.