Executive office update: The thrill of Democracy

Monday, July 01, 2013 12:07 PM
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Alfred Gilchrist, Chief Executive Officer
Colorado Medical Society

There is a tendency to review a legislative session postmortem as though it were a freestanding episode, with no prequel or sequel. In fact, most legislative sessions run along a continuum that builds on its predecessor’s actions or inactions and is philosophically guided by the previous election cycle.

Even with Colorado’s term limits, institutional memory can reach back for a decade or more, assuring all forms of karma and payback, and, thankfully, the wisdom borne of sometimes-painful experience. In this session alone, we saw legislators switch positions after exhuming a simmering resentment against us that had its origins in fights over the previous decade. Legislators also walked the plank for us under considerable lobby pressure because of the unwavering support shown by CMS and physician constituents during previous election cycles.

The point is that relationships cultivated at the grassroots level – whether homegrown or organic, ambivalent, hostile or collegial – are the essence of the legislative dynamic. The policies CMS offers to the legislature have to be internally settled by consensus, grounded in experience and clinically sound reasoning, then framed in a context that is appealing to a lay legislature that processes our proposals against counter proposals or determined adversaries. It is a combustible mixture of pragmatism and ideology.

These interactions are cumulative, by definition political, and embedded in a rational process that is neither moral nor immoral. As George Bernard Shaw observed, “Democracy is a device that assures we shall be governed no better than we deserve.” It is not a fixed game, as some cynics might insist when their ideas can’t get past the bill filing or public hearing phase. It is a game of chance, opportunity, and skill. How well we prepare from the political and policy development phases and into the legislative process that will make those policy choices, and how well we sustain homegrown relationships with elected officials who will influence the outcomes, is paramount. In other words, timing can be everything, but we can make our own luck by concentrating on evidence-based policies, grass-roots political involvement, smart message framing and hard work.

Medicine’s agenda runs both right and left of center. I have had the luxury of advocating on behalf of the medical profession in political environments that have been dominated by Republican and Democrat governors, as well as Republican and Democrat governing majorities. The viability of our health care policy “ask” mix will vary on the relative voting strengths of the majority party and its respective ideologies and leadership. A Democrat-centered body will tend to support financing and delivery system innovations – Medicaid Expansion in Colorado moved along party lines – but also be sympathetic to “fairness” arguments for expansions of civil and governmental liability. A Republican-centered body will generally reject liability expansions while tending to resist health care funding expansions. It is of course more complicated than that. Conservatives can view some types of health care expenditures as an infrastructure investment more than social welfare, and liberals have rejected the trial attorneys’ often one-dimensional asks to expand liability. Local constituencies do not always give their elected officials a clear signal on health care policy.

Notwithstanding the challenges for those willing to cross the partisan divide for the sake of policy, Colorado still manages to find a bipartisan sweet spot on health care issues more often than some more sharply divided states. We are farther along in the development of a Health Insurance Exchange and an entire range of system reforms that encourage collaboration and patient safety than most of our counterparts because of a pragmatic center that can still gel when offered rational options and compromises.

Over the course of many sessions, Colorado’s political culture has proven to be durable and reasonably open to the competition of ideas, and tends to default to evidence-based policies. It is responsive to strategies that take the longer view, as we emphasize in tracing the origins of the legislative progress in health policy in this recently adjourned session. It is a process that endures, despite the best efforts of some to thwart or disable it.

Posted in: Colorado Medicine | Legislative Updates | Initiatives | Advocacy


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