Insights July 2009

Why Healthcare's Critics Don't Matter

Neil Seeman

In healthcare, is "everyone a critic"? Traditionally, it paid - in attention, in stature - to be a critic, the more intemperate and ideological the better. Not so today; times have changed. Censure has given way to suggestion.
When I wrote about healthcare for newspapers in the 1990s, the editorial writers said their job was to "shoot the troops as they were coming home from battle."

Now these same writers are out of jobs. To them, the major policy debates in healthcare in this country focused on the role of private healthcare in a publicly funded system. That debate, as most people who work in healthcare well know, is a public policy side-show: it lends itself to stridency and polarized positions. The partisan media, on either side of the ideological fence, played up its significance.

Today, thanks to diverse online media and a changing generational ethos, constructive ideas in healthcare get more attention than "I'm right, you're wrong" chest-thumping. We stand at a welcome moment in human history. Positive recommendations on how to improve the quality and sustainability of healthcare systems receive rapt attention. The pamphleteers and the critics no longer matter.

Consider the evidence.

  1. The TED (Technology, Entertainment, Design) conference is the most prestigious intellectual venue in the world - the Nobel Prize of constructive, game-changing ideas that stress creative cooperation ("ideas worth spreading"). As of April 2009, TED talks had been viewed over 100 million times by more than 15 million people. The theme for next year's conference in Oxford is: "And Now the Good News."
  2. Most of the most widely read healthcare blogs - of which there are hundreds of thousands on the World Wide Web - are run by patient advocates, clinicians, researchers, students and technology experts who are not in the business of criticism. They have constructive things to say about how to improve healthcare. (among the most popular health blogs on the Web) offers healthy tips for weight management and exercise (one blog post recently compared the health benefits of squats vs. lunges). The two most popular mainstream newspaper blogs, the Wall Street Journal's health blog and the New York Times' health blog, are free of partisan mudslinging, focusing instead on objective news content and wellness tips. Most important, popular blogs such as these and emergiblog ("the life and times of an ER nurse") encourage interaction, commentary, and collaboration.
  3. In Canada, the role of the market in Medicare has been eclipsed by public debate over how to contain chronic disease. Even the wait-times controversy has slipped off the radar. This has changed the tenor of public discourse around healthcare. So patent and profound is the impact of chronic disease on human health, and on the public purse, that it has chipped away at partisanship. Instead, elected representatives of all stripes now speak to "evidence-based" solutions - the phrase is increasingly heard in parliamentary committees - to tackle chronic disease issues, from diabetes to cancer to mental health. Arguing by anecdote and vituperation has become less common in the public square.
  4. Even in the context of formerly acrimonious debates, notably, the role of the market in Medicare, post-partisanship hangs in the air. It's more than just the summer lull. Canadians seem to have less interest than Americans in television "debates" featuring extremist opinions on healthcare. We have matured.

Enough with the Critics

Healthcare is hard work. It's relatively easy to peck at your opponent's position. It's harder to stir up constructive ideas for change. It's far easier to destroy than to build and, in Canada, we are building. To the unconverted, please join us.

About the Author(s)

Neil Seeman is Director and Primary Investigator of the Health Strategy Innovation Cell, based at Massey College, University of Toronto.


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