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Consensus: A Clever Way To Build One, Whether It Is Right Or Not: Part 2

Stanley Feld M.D.,FACP,MACE


Consensus is usually defined as a general agreement by groups of people. Consensus decision-making is the process of developing a consensus. A consensus is theoretically inclusive, participatory, cooperative, and egalitarian. Egalitarian means all stakeholders in a consensus decision making process should be afforded equal input into the process. All stakeholders should have the opportunity to table, amend or block proposals.

The consensus decision making process should be solution oriented. It should strive to be all inclusive, promote compromise and resolve positions of difference.

President-elect Obama issued an important challenge to forming a consensus.

"In order for us to reform our health care system, we must first begin reforming how government communicates with the American people," Obama said in a statement yesterday. "These Health Care Community Discussions are a great way for the American people to have a direct say in our health reform efforts."

The consensus decision making process has been contaminated by President-elect Obama’s healthcare transition team in order to arrive at Tom Daschle’s predetermined solution. The results of the consensus building will be molded to fit the ideas the Secretary designate of HHS has to repair the healthcare system.

Dr. Val Jones had a Healthcare Community Discussion in her home. It seems the healthcare transitions teams goal is accumulate as many horrible healthcare interface stories as they can to use as evidence of the need for the new bureaucracy to be imposed on the healthcare system.

“President-elect Obama and Secretary of HHS designate, Tom Daschle, invited concerned Americans to discuss healthcare reform in community groups across the country. My husband and I hosted one such group at our home in DC yesterday. Although we had been instructed to compile a list of compelling stories about system failures – instead we decided to be rebellious and discuss “what’s right with the healthcare system” and compile a list of best practices to submit to the website.

Even in Val’s attempt to be rebellious she had only one physician in her group.

“The event was attended by a wide range of healthcare stakeholders, including a government relations expert, FDA manager, US Marine, patient advocate, health IT specialist, transportation lobbyist, real estate lobbyist, health technology innovator, Kaiser-trained family physician, medical blogger, and EMR consultant. Here is what they thought was “right” with the healthcare system:”

The deck is intentionally being stacked against the private practice of medicine. It ignores the fact that eighty percent of the medical workforce is in private practice. Uwe Reinhardt said do not get your workforce mad. I would think private practicing physicians as a stakeholder should have significant input into forming a true consensus.

President-elect Obama has picked up a hardheaded political strategist in Tom Daschle for his push to overhaul the nation’s healthcare system.”

I believe President –elect Obama has a great chance of overhauling the healthcare system. The problem, in my opinion, is elements of Tom Daschle’s overhaul are wrong. The public opinion manipulation will probably get some legislation passed, but will it be the best?

“ Learning from Clinton’s mistakes, the nominee for Health and Human Services secretary favors going on the political offensive to bring about reform.”

A common denominator in this consensus building is everyone agrees something has to be done to fix the healthcare system. The next administration is close to developing this common denominator. They are not building a consensus on what should be done. This issue has already been decided by Mr. Daschle. It does not matter if what is done is wrong.

“Guided by lessons from President Clinton’s healthcare debacle 15 years ago, Daschle has put a premium on cooperation between the White House, Congress and major healthcare interest groups, many of whom agree that major action on healthcare is vital.”

Bertrand Russell said it perfectly.

What a man believes upon grossly insufficient evidence is an index into his desires — desires of which he himself is often unconscious. If a man is offered a fact which goes against his instincts, he will scrutinize it closely, and unless the evidence is overwhelming, he will refuse to believe it. If, on the other hand, he is offered something which affords a reason for acting in accordance to his instincts, he will accept it even on the slightest evidence. The origin of myths is explained in this way.”

Naomi Klein in the Shock Doctrine said in times of economic or political upheaval policies are enacted that could never have been passed in ordinary times. We are not living in ordinary times.

“Tom Daschle favors moving decisively to seize political momentum and, if necessary, cut off opposition, something he said Clinton failed to do in 1993.”

"This means going on the offensive," he wrote in "Critical," his recent book about healthcare,”

I do not believe Tom Daschle is going to repair the healthcare system. He does not fully comprehend the problems in the healthcare system. Brute force will not work. Aligning stakeholders’ incentives is the only thing that will work.

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