Gary Oftedahl: Godwin's Law--and health care reform?

I practiced medicine for more than 26 years as an internist.  Subsequently, I’ve spent the last 7 1/2 years working at the Institute for Clinical Systems Improvement focusing on collaborative, evidence-based approaches to improving care.  Our work over the past 3-4 years has become increasingly complex, moving from providing quality improvement training to our member organizations, to facilitating and convening multi-stakeholder initiatives addressing both practice redesign and payment reform.

With that in mind, the concept of “health care reform” seemed a timely opportunity to see major national policy issues addressed which would support and ultimately contribute to the success of our evolving work.  Naively (hard to believe that at 62 I’m still capable of that personality trait) I felt this offered an opportunity to engage in real change.

Obviously the vitriol, misinformation, and verbal and physical violence being propagated from all sides in the past several months has impacted that naive and perhaps utopian perspective.  It had been exciting to read Peter Senge’s book Presence and contemplate the value of dialog and obtaining shared vision.  It was intriguing to contemplate the application of Otto Scharmer’s Theory U to our collaborative efforts–engaging in opportunities to focus, broaden, and deepen our collective viewpoints–in coming to a shared vision of reform.  Ron Heifetz’s adaptive leadership model seemed a totally natural opportunity to apply to this circumstance.  Unfortunately, the activities and actions seen thus far are more reflective of an introduction and advancement of Godwin’s Law to the health care discussion.

You’re not likely familiar with this whimsical, initially humorous observation coined by Mike Godwin in 1990 which referenced a trait seen in the Internet world–”As a Usenet discussion grows longer, the probability of a comparison involving Nazis or Hitler approaches 1.”  Godwin’s Law, as it became known, applies to inappropriate, inordinate, or hyperbolic comparisons of other situations to the actions of Hitler and the Nazi regime.  While initially intended as a humorous reference (although one would caution that using Nazi references rarely is an appropriate tool for comedy), the concept has expanded to cover the escalating emotional responses  to a particularly complex, controversial topic.  Whimsically, it is said that the first one to introduce the reference to Nazism in an online discussion automatically “loses” the debate in progress.

While primarily applied to the Internet and the ongoing discussion threads which increasingly permeate and populate the Web, it strikes me that we’re seeing  this played out in real life in the national, state, and local discussion of health care reform.

Without going into detail, it appears that we’ve heard Nancy Pelosi suggest that the conservative element is guilty of Nazi tactics, and innumerable conservative pundits (does the name Rush Limbaugh come to mind) have used Hitler’s name in discussing the activities of President Obama.  Now, I’m not a history buff, and certainly not expert enough to go into a lengthy discussion of the merits of these claims philosophically, but  when widely disparate political viewpoints suggest that each other is guilty of Nazi tactics, Godwin’s Law is being invoked.

What does this mean for our discussion on health care reform?  An article in The Economist in 2007 suggested that “a good rule in most discussions is that the first person to call the other a Nazi automatically loses the argument.”  Great, who did it first, and does that solve any of our issues?

The answers to health care reform are complex, finding a simple solution is unlikely.  We need to embrace the  complexity.  But in a time of uncertainty, fear, and upheaval, people are looking for certainty, strong opinions, and a commander mentality to reassure them.  Not seeing that they fall back on name calling, and threatening and emotional responses.  This is becoming increasingly evident in the ongoing town hall discussions on health care. Godwin’s Law seems to be among us.

Whether we can truly make the changes needed to transform health care, or continue to perpetuate a  dysfunctional system because of our personal views and needs, demands a level of respectful dialog not witnessed in the present arena of debate.  While whimsical in nature, Godwin’s Law demonstrates we have reached a dangerous level of name calling–and since both sides of the debate have been involved–we’re each losing the argument.  How do we move forward from here?