What Do Health Care and the Mega Millions Lottery Have in Common?

As a lifelong student of leadership, I enjoy looking at the events that capture national attention and examining what they say about who we are as a society and how we are leading in our lives.
It seems nothing is as riveting as the Affordable Care Act’s three-days at the Supreme Court. The debate over healthcare or as some have dubbed it “Obamacare” has galvanized the nation along its well-know red and blue partisan divisions. How is it that the world’s most affluent country, with the most expensive health care system still has a dismal record on health care with tens of millions of people unable to access it?

While I completely conquer with the assessment by Auerback and Wray that health insurance is not synonymous with health care and that a single-payer system, while politically untenable is the more economically sound approach, at its core the health care dispute is at the place where America is stuck on many policy fronts. That is, there is an unresolved tension between what we want for ourselves as individuals and what we want for our community and country.

Some indisputable facts:

• Everyone consumes health care.
• No one knows if they will require a little or a great deal of care or when they will need it.
• When someone needs care they want to get it right away.
• As a society, we have already agreed that anyone who needs care will receive it if they get themselves to an Emergency Room.
• Most people always assume that “bad things” happen to other people until they are the ones faced with chronic illness or a catastrophic accident.
• Untreated sick people can become a threat to public health.
• For most services where there are free riders and when individual access has both personal and community implications (e.g. it is impossible to have an army that only defends a certain portion of the population) the government is the provider because it is the entity that best balances the interests of personal and public without a profit motive.

From the left and the right, health care is in a ditch because of two key factors: on the right the vitriol has become so heated around the interests of the individual that they have dismissed all sense of connection and the inevitable consequence of one person’s behavior on another; and on the left, lack of inspired leadership in government has created a bureaucracy of mind-numbing regulations that now hinder one of its central functions of balancing personal and communal needs in a vibrant and responsive way. Take any issue, education, environment, economy they are all stuck because we have polarized the choices to such extremes that for the bulk of Americans neither path is palatable.

So what does all this have to do with the lottery? It is a fascinating juxtaposition of these issues. As the jackpot grew, millions of Americans were willing to shell out one to hundreds of dollars for the minuscule chance to become a mega-millionaire. Contribution to the lottery was justified because there was the possibility that they could be the one who would win it all. No one forced them; in fact, most people were positively giddy about the opportunity of winning and the chance to free themselves of ever having another financial concern. Yet, the suggestion that everyone would pay into a system that would guarantee health care for all who need it, in hopes that it would never be them, seems to be akin to sidling up to the devil himself. Why is it so easy to open our pocketbooks for the slim chance to be a millionaire and yet we are revolted by the notion of contributing to health care for those who may need more of it than they can afford—including ourselves?

Which brings us to an important insight into our national psyche, and perhaps that of most human beings, we don’t like to be told what to do and we don’t like to feel as if we don’t have a choice. The Affordable Health Care Law has become the punching bag of the right over this issue alone. Any time someone unfurls the banner of “government good” the right goes after it like a dog with a bone.

So how does health care become like the lottery, where people actually want to participate? In a word—leadership.

While the intricacies of how to accomplish this cannot be detailed in a single article, the strategy of getting there is straightforward. Leadership is about helping people reconcile their conflicting beliefs so that individual values are aligned and are shared throughout communities. Because elected officials fear this challenging conversation, they would rather deal with the details of who pays for what, when and how rather than working with the public to get to a point where everyone can see the benefits, personally and societally of a well-functioning health care system.

Ask anyone and they will be able to come up with a list of obvious ways to improve health care. It is a system where no one, other than the insurance executives and their shareholders, are satisfied. Before we can get to the concrete work of improving the quality of what is offered, it is important to come to a fundamental understanding and agreement to the facts listed at the beginning of this article. Without an agreement around the basics and a reconciliation of the desire to “get government out of my life” while wanting the benefits of living in a well-functioning society we will never get anywhere.

Regardless of the Supreme Court’s decision in June to uphold the health care law or not, we will still be a long way from true change—and with a good majority of the country enraged by the pronouncement. Without a leader willing to engage in a substantive dialogue our health care system will continue to deteriorate.

Perhaps the best we can do is to keep buying those lottery tickets hoping we are the lucky winner who needn’t every worry about health care costs. Or maybe we can feel good about building a system where everyone contributes what they can in hopes they will never need it and knowing it will be there if they do. Now that’s a lottery where everyone wins.

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