Medical Device Daily National Editor

All kinds of factors are being cited these days to support the hope for large, and real, reform of the U.S. healthcare system and a drive to make sure that all – or nearly all – of Americans have basic healthcare:

• Democratic majorities in the House and Senate that will back a Democratic president who has promised to make such a change.

• The increasing runaway costs of this "system's" dysfunctional operations and the need to reduce its inherent wastefulness.

• A severe recession casting people out of jobs, out of homes, out of healthcare and the need to reverse this tide.

• Calls for reform at the top of the healthcare system, from prestigious medical associations and even the insurance industry itself.

• And a groundswell of grassroots support for no-nonsense reform, reinforced by the President-elect's use of the Internet to gather conversation and new ideas about the necessary changes.

I think there are two other reasons why significant reform – not simply twistings and tweakings – could happen: one, that even those with health insurance are disgusted with this industry; and two, that the word "socialism" has lost its meaning – and its power to frighten.

All in the same boat

In a recent New York Times op-ed piece, a psychologist noted that human beings tend to rate their satisfaction in terms of their relative position with others. For instance, he noted research saying that, given two choices, A) making $50,000 a year when everyone else is making $25,000, or B) making $100,000 a year when most others are making $200,000 a year, most people choose A. (And H. L. Mencken defined wealth as "any income that is at least $100 more a year than the income of one's wife's sister's husband.")

The psychologist said that this kind of thinking helps to explain why there seems to be no great outcry of misery in the U.S. today – because so many seem to be in a similar sort of boat, maybe not losing a home or a job, but at least seeing a 401(k) melt away.

The same type of argument can be used to explain why most of us feel the need for massive changes in U.S. healthcare.

Even those with healthcare insurance feel under-insured or abused by private insurers, seeing the all-too-obvious: that the main objectives of these companies is to avoid coverage, that the interminable debates concerning what should and shouldn't be covered contribute to the expense and wastefulness of the system; and that there is a general need to reduce this "middle-man" activity to as little as possible, so that healthcare resources can be put where they should be – to "health" and to "care."

(And ask any tech, nurse or doctor in a physician's office today what they think about the current insurance system, you know their response.)

Ideology on the ropes

Even more important is the declining power of the word "socialized" and the new president's commitment to pragmatic solutions over ideological inertia.

I well remember the frequent rants, some 40 years ago and more, by one of my uncles, a general practitioner, against the evils of "socialized medicine."

The connection to communism didn't have to be spelled out – it was obvious. Socialism was just one tiny step away from that red abyss over there in Russia. And that one word, "socialized," has been invoked over and over by every opponent of universal healthcare to demonize it as the ultimate evil, beyond the pale by any right-thinking American.

The power of that single word has been used to invoke a whole host of fears: that a "socialistic" system would undermine individual freedom and personal responsibility and hand us over to heartless, Godless bureaucratic tyranny. Meanwhile, with politicians and the public in the grip of these fears, thousands and thousands of human beings, most of them the newborn and the elderly, died because denied access to basic care.

But Barack Obama has made it clear that he is a pragmatist, not an ideologue, that he plans to seek out those things that will work, abandon those things that do not work, and that he will pursue what is best for Americans, not hold fast to ideologies and ideological thinking that provides more harm than good.

The supposed evils of "socialized medicine" will, of course, continue to be invoked, dogging every effort to alter U.S. healthcare in a significant manner.

But the power of this word to scare is essentially gone, dead on arrival for most Americans. We have seen too many countries adopt universal healthcare, many on average having a better level of health than their American counterparts – and at less cost – without slipping into the evils of communism. And we are tired of being driven by ideologies that promise simplistic solutions that invoke unthinking loyalties that deny how human beings behave and react.

Obama has said that he did not wait another four or eight years to gather more credentials and "experience" to run for the U.S. presidency. Rather he said he sees that this is a time for action, a time to brush aside the poured-in-concrete ideologies that have created so many of our current ills and stifled intelligent reform.

His legacy will be defined in terms of his ability to do this – either succeeding with bold new steps, or, falling into the trap of the many before him, succumbing to simplistic ideological mantras that ignore the everyday realities and challenges that all Americans face.