Sunday, August 30, 2009

The declining health of the health care debate

Congressman Mike Rogers' opening statement on Health Care reform has made the rounds on the Internets lately (over 1 million views, in fact).  It takes a good conservative with solid beliefs like Rogers to effectively enunciate philosophical principles in a rational tone that doesn't slide into personal attacks or obvious hyperbole.  I'm not sure if everyone can, but I can feel  the common-sense-ness of his argument when I listen to him.  Watch for yourself:

Yet, hyperbole is throughout Rogers' speech, but good luck finding someone to call him out on it.  The reason?  I'd argue that philosophical hyperbole is harder to notice, and is also more difficult to combat.   But that's why we have Between the Columns, right?  Right.

With that, let's dissect Rogers' speech:

He starts by saying that the Democratic plan is "abandoning the very principles of America" by "punishing" the 85% of Americans that have health care insurance to expand coverage to the remaining 15% who don't.

Let's start with his so-called "principles of America" hyperbole.  I just went through the Bill of Rights and the Constitution and didn't see anything supporting his statement in our nation's principles.  In fact, I did see in the preamble of the Constitution a little ditty where it says that we, the people are to "promote the general welfare," among other duties.  Arguably, expanding health care coverage is well within our stated principles.  But even if you disagree with this interpretation of the preamble, it's hyperbole to state outright as Rogers does that it's against our nation's principles.

Then there's the hyperbolic notion that supporting the less fortunate among us is "punishing" the majority of us who are insured.   I'm no religious scholar, but I believe most mainstream religions actually promote helping those who cannot help themselves.  But I digress; let's cirlce back to the economic perspective:  The cost of the emergency room visits for the uninsured cost us plenty economically, and the very notion that uninsured people wait too long to get help is unhealthy for all of us.  They spread diseases more readily, and they cost us more when they get treatment. 

By the way, Mr. Rogers, every corporation invests in underdeveloped areas of business by applying the profits of successful sectors disproportionally to these emerging areas.  It's considered smart business in the world of capitalism; not punishment.

I will give Mr. Rogers the point that he is not given any choice but the Democrats' choice or nothing.   That's not hyperbole; that's what you get when you're the minority party.  And Rogers has a fair point about needing a debate around how we solve this problem. 

Regarding cancer treatment in the UK and Canada, it is true that America has the best oncology practice in the world.  But that has absolutely nothing to do with who's paying the bill.  The Democrats are proposing insurance reform, not health care reform.  It's a huge difference, and one that is not nearly talked about enough!  Government insurance will not change oncology health care in this country no more or less than any other private insurance company's rules apply to coverage. 

This is so important, it's worth repeating:  The plans on the table surround insurance not health care.   As a result, we can not compare these plans to socialized health care systems in Canada or Europe.  It's apples and oranges, people.  If you understand this concept, please forward this post around to your friends and family so that they can understand the difference.

Rogers then makes a point around Democrats "not letting the private sector fix this problem."   This is where Republicans are on shaky ground.  The private sector is the sector that has been sending the health care system into the emergency room!  The (impending) failure of the private sector is why President Obama and the Democrats are pushing for a proactive solution to this huge problem.   I think there should be a healthy debate around who is best suited to solve this health care problem, but I do not think is helpful when conservatives turn a blind eye to the very free market systems they cherish.  No system is perfect -- not government, and not the free market.  And if a particular sector is failing a system, then it's time to re-evaluate and try something new.  In my view, that's innovation, not socialization.   And it should go both ways.  And, for better or for worse, this nation elected Obama based in part on his health care reform position.  Elections matter, and there should be a little democratic deference to this reality.

Rogers' last point about other government regulations as a tyranny of government control reminds me of the libertarian who told me that if the government would just leave him alone, he could go ahead and earn a decent living.  I asked him what he did, and he said that he was in home construction.  I wonder how good his business would be if the federal government would stop getting in home owner's shorts with that tax refund?

Monday, August 17, 2009

The Problem(s) with the "Public Option"

Obama's health care reform strategy seems to be finding most of the substantive contention around the "Public Option." I've got some bad news for the administration and its supporters: the Public Option's got issues. A lot of them. And they may even be terminal.

Here's a step-by-step guide to problems with Obama's cornerstone of health care reform:

The Words
The two words in play, public and option, do anything to advance the meaning of the concept they are attempting to describe. "Public Option" reeks of echo-chamber-liberalism-trying-to-market-itself-as-acceptable language that, no surprise, hasn't worked.

The first problem is the word "public." "Public" indicates it's for everyone... like how a public park is for anyone who wants to enjoy said park. Yet, as legislation is evolving, the "Public Option" would not be for everyone. It'd be for some people, and in most bills in development, there are strict limitations on who can join the "Public Option."

Then there's the word "option." This is supposed to indicate that we as Americans will have another option in health care insurance. Yet, again, many will not have this option because -- thanks to the conservatives being so worried that if everyone takes this "option" then there will be no more private insurance -- there are a lot of firewalls defined that don't allow the Public Option to be a viable option for many who currently are covered by private insurance.

The Meaning
"Public Option" not only means nothing without additional context, but it also evokes socialistic sub-contexts thanks to the use of "public." In the supposedly less marketing-savvy days, some really good marketing/branding folks devised the terms "Medicare" and "Medicaid." The talent that named these programs must have long past, because "Public Option" pales in comparison. What does "Public Option" mean with very little context? It means that the public has an option. Why would the 80% of Americans who already have insurance want to pay even more taxes for another option that most won't ever use?

What the public wants is lower costs, better quality and -- when possible -- broader access. None of these meanings are conveyed by the term "Public Option."

The Message
The messengers for the "Public Option" really fumbled by not having a cogent response to the detractors who state that if a public option is so good, then why would we need private insurance companies? Take this to the logical conclusion, and if the government can provide superior services, then we will end up with a "single payer" system, which the Obama administration promises is not on the docket (even though Obama himself claimed that he was personally a proponent for single-payer as a U.S. Senator a few years ago). So, the lack of a strong defense against this Trojan Horse concern has given the detractors credibility because they're gaining traction in the "what comes next" argument.

The Policy
I'm all for Obama's "thread the needle" approach to policy, but moderation is not really in the cards with the American culture these days. As much as the average American is centric/moderate, we as a culture reward Big Plans with Big Visions and Big Solutions. This is why so many embraced the Bush Doctrine of foreign policy even though it's since proven to be a quantifiable foreign policy disaster. We like compromise as a nation, but not at the expense of avoiding the tough choices needed to reform things. Americans like to vote for things that involve no pain, but we also like being told to suck it up and to be tough. The "Public Option" is really a middling policy that isn't really a Big Idea and really doesn't ask us to give much up.

Yet there is a more practical, systemic concern: As much as I think the free market has all but failed America in terms of health care insurance and cost containment, pitting a government plan against private industry is just not the right role for government. Government should not be competing with industry -- ever. It should be enabling economic growth, while protecting the rights of citizens, ensuring fairness, healthy competition, and taking responsibility for the administration of public good works. Under this model of government, health care reform should come in one of two flavors:

1. Go completely single-payer, where we extend the 6% administrative overhead of Medicare to replace the 20-30% overhead of private health care insurance companies. Leverage economies of scale and completely transform our health care system to align with the the notion that our health and well-being is more important than shareholder profits. Single-payer has shown to improve outcomes, life expectancy and costs in many nations already. Yeah, it's got its own problems, but better health care is better health care. And single-payer has proven out to provide better health care on a macro level.

- OR -

2. Play the full regulation card, where the government enforces strict regulations on a completely private health care system. This would keep everything in place as it stands today, but introduce new, tough "rules of the road" that all insurers must abide by, equally. This would include universal access to affordable insurance, no limits on pre-existing conditions, no dropping of coverage, etc. In other words, the government plays the role of citizen advocate and referee, and ensures that the business of health care insurance is more equally balanced between profits and keeping Americans healthy and alive. In addition, the government could and should enforce innovation in automation and administrative cost controls across insurance firms on behalf of citizens. This regulated industry approach has a lot of precedent, and would have the extra-super-double bonus of costing merely a fraction of adding a Public Option to the mix.

Either of these approaches to policy could work, and each has its pros and cons. But at least both of them present a level of policy clarity that people can better understand, contemplate and opine upon. The "Public Option" is so vague and un-descriptive that the idea of "death panels" has risen from the murkiness. It might feel better to blame Sarah Palin (who made Obama's so-called "Death Panels" famous) for derailing the dialog around health care reform, but I'd argue that it's the echo-chamber-policy-wonks who are to blame for poorly naming, positioning and selling health care reform in the name of the "Public Option."

Don't get me wrong -- there are a lot of benefits to the Public Option scheme. It's just that these benefits are not seeing the light of day, in part, due to the issues outlined here.

Friday, August 7, 2009

The Rahmifications of Emanuel

Soon after Barack Obama won the election, he began announcing his cabinet and staff picks. As soon as I heard that Obama had picked Rahm Emanuel to be his Chief of Staff, I twitched in disbelief. Really? Mr. Hope and Change meets Mr. Fuck and You?

Many friends (and the media) tried to comfort me with the notion that Mr. Nice Guy needed Mr. Tough Guy to rattle the cages and shake the congressional tree. OK, I thought, maybe Obama needs an experienced and feared heavy to cut through the nonsense on Capitol hill.

Now that we're 200 days into the Obama administration, I'm starting to really think that Rahm might be the kryptonite to Obama's Superman. Obama's popularity has been plummeting rapidly over the summer, and his handling of the health care debate is in Bush/Cheney territory in terms of popular support.

The tone was set early by Rahm himself when he said that a crisis should never go to waste. This is such a cynical, anti-Obama campaign sentiment, that it's remarkable that Obama kept him on. But, like all leaders, Obama I'm sure has fallen for the confident, get-it-done, damn-the-torpedoes, I've-been-here-before Chief of Staff that says "don't worry, boss, I've got it all under control for you." Every boss wants to hear that, and will give a lot of leash as a result.

So, here we are, with Mr. Hope and Change now defending his citizenship, his economic stimulus package, his bail-out of GM and of Wall Street, and now his attempt to reform health care. My, how far he's fallen from election day.

If I were to advise the President, I'd offer the following suggestions:

1. Identify and label the pillars that comprise your domestic agenda. Under, the "Rebuilding America" agenda, form the 5 pillars that are critical to success:
  • Making high quality health care affordable for everyone
  • Transforming America's energy policy from black to green
  • Making education a strategic advantage for America's children
  • Regulate the financial industry to avoid future malfeasance
  • Regain our respect and position as a global leader
2. Frame all initiatives, laws, policies and speeches in one of these 5 pillars.
3. In every televised event, put up signage representing one of the pillars to reinforce the theme of the event
4. Whenever attacked, go back to the baseline theme (above) of the issue at hand, and use the same words each time. For instance, if someone says that you're trying to socialize health care, your response would be "No I'm not; I'm trying to make high quality health care affordable for everyone."
5. Continually remind people -- often -- of what you've done so far in each pillar in an effort to fulfill your commitments you made in your campaign. If someone asks why you're looking at health care now instead of the economy, your response should be "because in my campaign, I promised this country that I'd fix health care. I'm not going to back down from my commitments."

Why am I attempting to give the President tips on my blog? Because I think that the approach the administration is taking now (along with congress) might actually damage his ability to lead as President. This is not good for anyone. I've heard that, due to the lack of support from even some Democrats, Obama is not opposed to pushing through his agenda with 50 Senate votes (a procedural vote allows him to do this). This might pass the law, but it will put a large dent in Obama's campaign promise of a "new type of politics in Washington." This kind of hit to his brand will be very difficult to recover from.

So, Mr. President: In the name of following through on our campaign commitments, I advise you not to follow Rahm's advice, and not to accept his style in passing health care reform. I expect that you, as President, will have a strong enough center to use your natural positive leadership skills to successfully navigate this political maze. You cannot afford to approach this the way Rahm would. Yes, he might be effective, but any success achieved his way will exact a much larger toll on your personal brand equity.

Saturday, August 1, 2009

The iPhone, AT&T and the role of government

A recent TechCrunch article effectively outlines where private industry and government collide as they describe the situation behind Apple (and/or ATT's) rejection of an iPhone application written by Google that would circumvent the wireless voice network that AT&T provides iPhone users. Of course, this application still relies on AT&T's wireless data network (when WiFi is not available), but it really does serve as a disruptive technology as it replaces AT&T's phone number and voice telecommunications infrastructure. Think of this Google app as a kind of Skype of mobile phones.

This situation belongs on Between the Columns because of the role that government is playing in this situation. Here we have multiple companies developing and innovating around technologies using their own investment dollars, navigating a tricky landscape of competition and cooperation in order to profit and serve their customers' needs. As they make decisions that are best for them to protect their investments and strategies, the government jumps in, feeling the need to protect consumers from large companies who can use their dominant positions to limit consumer choice and hinder innovation.

It's fairly easy to presume that liberals and progressives would support this type of action. After all, the progressive mantra is to create equality and fairness wherever there is a systemic imbalance. My question is: where does this role fit into the conservative philosophical framework? Presumably, this is government interfering with the free market, which would be bad. But if the government does not intercede, then one big company -- Google -- will be limited in its ability to grow and prosper in the mobile internet market. Is that fair? Was it right/fair for the government to break up AT&T in 1982? Did that unleash new industries, competition and fairness in the marketplace? Or was it wrong for government to get involved in a successful, dominant company that had earned its dominance by being first-to-market? Should AT&T in 1982 simply have been better regulated? When is regulation not enough to solve a problem?

This actually introduces some interesting questions as we consider the current health care reform debate. For instance, a conservative commenter here at Between the Columns asks why health care reform simply can't be a regulation activity vs. the larger, systemic change Democrats are pushing for with a "public plan."