Cutting through rhetoric for truth

I try hard most of the time to not “let my lawyer show.” This is not one of those times.

I know everyone has read and heard much about the recent U.S. Supreme Court ruling on the Patient Protection and Affordable Care Act.  So, I won’t favor you with another legal analysis complete with an attorney’s glee at being “right” in the outcome but “wrong” in the reasoning (or vice versa). The most interesting part of the decision’s impact on healthcare delivery and insurance markets have been well covered by experts. Instead, I wanted to look at the decision from a different perspective.

Chief Justice John Roberts and the majority followed a fundamental truth of legal analysis experts often forget. When a law is passed by the other two branches of government (executive and legislative), it is the judiciary’s obligation to find any and all legal and constitutional arguments in favor of upholding the law. This applies in all areas of law, in all cases, in all U.S. common law-based courts (meaning everyone but Louisiana – another story altogether). The court did this in the final ruling, and the new law stands, with the exception of the now newly-minted constitutional restriction on coercion of states to adopt federal programs in extreme cases. This is the first time the “coercion” doctrine has been confirmed at this level of legal evaluation – but I digress.

Why is this fundamental truth in decision making important? It is a lesson in analysis of complex issues and one we should take to heart. The court read every word of every brief and thousands of pages of instructive legal precedent. The justices learned the excruciating details of a healthcare reimbursement system that is in disarray and heard of fragmentary care delivery models too complex for complete understanding by many of us in the field for 20-40 years.

But they decided the most important issues on a fundamental truth of law – the judiciary is an evaluator of law, not a policy maker. Policy is left to the other two branches of government. This is the ultimate in constitutional separation of powers. It is fundamentally important to a constitutional democracy. This is the disciplined part of excellent leadership.

All of us in healthcare can make our decisions in complex situations using fundamental truths. If the fundamental truths of healthcare are:

1. We do not want people to get sick – we want them to stay well; and

2. When people do get sick, we want to make them well with the least disruption to the patient and society;then our decisions, based on complex facts and circumstances,
can be made and articulated clearly for the world to hear and support.

As we continue to lead our employees and patients through the changes to come, we must make our ultimate decisions on fundamental truths. When things are most complex, these truths will guide us. Articulating these truths as the reason for change will gain the support we need for the changes to come. U.S. Supreme Court justices are this country’s leaders of the legal field. If they can cut through the rhetoric and make decisions on fundamental truths, so can all of us.