OP-ED

Op-Ed: Sustainable Healthcare Reform

President Obama made a risky wager when he decided to let Congress take the lead on crafting health care legislation, rather than presenting his own reform package. Congress is not known for taking bold, decisive leadership on tough issues. Normally, it reacts and gridlocks; it doesn’t lead.

As Congress takes its usual August recess without acting, it appears that Obama’s strategy has failed. But, has it? Is there a deeper strategy? What’s really at stake here?

Obama reportedly reasoned that Congress will do better in the long-run if it protects its institutional prerogative as law maker and doesn’t take on the appearance of being the President’s rubber stamp. This is a plausible calculation. The last time Congress was asked to respond to a President’s health care reform proposal during the Clinton years it did so by throwing the whole package in the trash can.

It is likely that there is more to Obama’s calculation than meets the eye. He knows that Congress is entangled with the health care industry’s massive lobbying and campaign finance money machine. Republicans and Democrats alike depend on special interest money to finance campaigns.

The only political force strong enough to persuade Congress to transcend the special interests is an outraged public. It’s all about the money to be sure; but even more so, it’s about what members of Congress really care about: votes.

Obama’s immediate problem is that the public is turning on him, not Congress, for failing to provide leadership. But this will be a temporary diversion of public anger if he now steps up with his own specific proposal.

He has placed himself in a position to press for substantive reform, including a measure at its core – the public insurance plan option. The best informed experts agree that a public option will drive down health care and insurance costs, and give virtually every American a chance to have affordable care. It will avoid simply throwing more money at a system that already costs way more than it should.

Throwing good money after bad will happen because the Congressional proposals add to the numbers of people who will be covered by the same insurance companies that offer coverage now. The proposals don’t offer a public option choice, and will increase the customer-base—and stock value—of insurance companies, whose track record on holding down costs isn’t very good. This helps explain why some insurance interests and their allies are now paying for ads in favor of health care reform; their version of it will produce a pretty good return on their political investments.

The proposals don’t hold down health care costs either. A public option will allow competitive and impartial introduction of the tools required to drive these costs down. The public option is the pathway to reversing the perverse incentives of the status quo which push costs of care and its coverage ever upward.

These incentives are driven by deep structural flaws in the current system, including an emphasis on specialty, rather than primary care, the lack of information technology needed to improve quality and ensure science-based decisions about care, and a fee for service system that creates incentives to drive costs upward. The public option plan provides the platform to launch these essential reforms, and to promote public choice among insurance carriers.

If Obama doesn’t aggressively pursue the public option, he will fall short of the character of leadership needed to ensure quality health care for the American people; and the promise of his presidency. His credibility with his supporters will be severely damaged; and his enemies will rejoice.

If he loses the battle of the public plan after fighting hard, at least he will be around to continue the war against “politics as usual.” Leaders and followers alike learn from battles they lose as well as those they win. Conviction and persistence, traits Obama surely possesses, are what matter most. Unless he presents a specific proposal with a public option and fights hard for it, Obama will be seen correctly as a politician, not a statesman.

The question is whether the public will do its part and whether Obama will do his. The public’s outrage is growing by the day as more and more Americans suffer from the increasing costs of health care and loss of coverage. If public reaction is not channeled in a positive direction, everybody in political power loses.

Those who think health care reform is a show down between the President and Congress or Republicans and Democrats miss the point. It’s a show down between government and the citizenry. Powerful special interests are squarely in the middle, trying to control the outcome as they equate the common good with their own.

It’s fair to conclude that the credibility of the entire American political system is on the line. While the battle is about health care, the war is about preserving, protecting and defending the viability of American democracy. The health care battle will demonstrate to the world the character of the American body politic, and the strength of its new president.

Perhaps most important of all, a hard-fought battle against the special interests will demonstrate whether democracy still works in the nation that first introduced it to the modern world.

Larry Arrington is a Florida-based planning and management consultant. With Herb Marlowe, he is co-author of Sustainable Governance: Renewing the Search (Llumina Press). The book is due out in fall, 2009. Watch for it at http://www.arringtonmarlowe.com/; and at http://www.llumina.com/.

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12 replies »

  1. All politicians with pride are saying: “In the USA is the best health care system in the world”. Oh, yes, they are correct, because this best health care system is for politicans, government employees and the rich.
    In the USA 18,000 Americans are dying each year because they have no health insurance. 46 million Americans have no health insurance.
    Why? Because of corruption of elected officials. So many CEO, of so many profit and so named not for profit organizations and institutions get salaries of many millions dollars and are buying politicians.
    Cut theirs of these lazy, overpaid cats and will be a lot of money to pay for health insurance of many people.
    Pavel Goberman – Candidate (D, but honest, incorruptible) for US Senator, OR (against moRon Wyden
    http://www.getenergized.com/vote.html

  2. This is a very comprehensive posting on the most debatable subject like the health care reform. Indeed there are lots of different opinion on this subject.

  3. David Kibbe’s thoughtful comment about my blog questions whether there is a correlation between Obama’s health care reform strategy and the measured approach Lincoln took to the emancipation of slaves during the Civil War.
    David suggests that Obama’s conundrum about aggressively pursuing a specific proposal of his own rather than leaving the heavy lifting to Congress, “…reminds me so much of the swirling debate about Lincoln’s plans to end slavery, which led up to the Emancipation Proclamation, and ultimately to the 14th Amendment.” David notes that many were angry at Lincoln “…for not taking more aggressive steps to end slavery earlier in the Civil War! And yet he waited until he felt he had a much broader coalition supporting emancipation, which included popular support…”
    The question is whether Obama is waiting for popular support to materialize. My blog suggests this is likely the case. Meanwhile, like Lincoln, Obama is taking much heat as he makes up his mind about how best to proceed in light of the nature and timing of the debate. David questions whether his correlation is a “stretch.” I don’t believe so.
    The following excerpts are from our book Sustainable Governance: Renewing the Search (Llumina Press), due out this fall:
    “As we shall see, Barack Obama aspires to lead during the present crisis in the fashion of the great presidents, guided by Lincoln’s sense of the American vision. Only time will tell whether the American people have the character and will to turn away from paralyzing and dangerous differences, and unite behind him. Americans, to achieve and sustain unity, will have to share the sacrifice demanded by the search for sustainable governance during times of great national challenge…”
    “Obama also seems to understand that connecting with Lincoln’s masterful understanding of the necessity of reconciliation and the path to unity has become the central challenge facing the nation. The struggle is not about winning a political or ideological battle. It is about preserving the nation’s vitality, promise, security and respect as a leader in the world. These matters reach to the most profound meanings of sustainability. During such times of crisis, thoughtful people of conscience must hope that the spirit of democracy, well practiced, will make its presence known and its wisdom apparent to leaders and led alike.”
    The spirit of democracy is quenched when special interests overwhelmingly dominate the process with their money and influence peddling. I argued in my original blog that the only force strong enough to transcend this abuse of democracy is an outraged public.
    In our book, my co-author and I also write:
    “Lincoln’s example teaches that reconciliation of America’s conflicts and contradictions requires transformative leadership. The appearance of such leadership is extraordinary, and requires a confluence of crisis with leaders of superior quality at the helm. This explains why the unity of consensus on complex and divisive issues is very difficult to attain; and why, tragically, the “better angels of our nature” come to guide our collective life only after much suffering brings the nation to its knees and forces the question: what do we truly value?”
    The key questions now are: Have Americans suffered enough to act on the conviction that we truly value quality and affordable health care and sustainability more than our obsession with ever-increasing consumption and investor profit making at all costs? Is Obama an extraordinary leader of superior quality? Is democracy still alive and well in America?
    Health care is the iconic issue before the nation, but there are many, many others we write about in our book.
    David shows me he is among those thoughtful Americans who understand what’s at stake.
    Posted by Lawrence W. Arrington, July 31, 2009

  4. Lawrence: You said “If Obama doesn’t aggressively pursue the public option, he will fall short of the character of leadership needed to ensure quality health care for the American people; and the promise of his presidency. His credibility with his supporters will be severely damaged; and his enemies will rejoice.”
    This is very well said, and I agree with you that he and most Democrats and moderate Republicans understand this.
    It reminds me so much of the swirling debate about Lincoln’s plans to end slavery, which led up to the Emancipation Proclamation, and ultimately to the 14th Amendment. The so called radical Republicans of his time and party were so angry at him for not taking more aggressive steps to end slavery earlier in the Civil War! And yet he waited until he felt he had a much broader coalition supporting emancipation, which included popular support, at least in the North and the border states.
    This will be seen as a stretch by some, but I believe that Obama knows he can’t win until he has broader popular support, and, just as importantly, that everyone else in the Democratic and Republican parties of today understands that he has broad popular support. That his position and that of Lincoln in early 1863 are quite similar.
    All of which goes to your many good points in a fine post.
    Thanks, DCK

  5. We are seeing now the impossible situation that multiple competing systems create – just what providers lobbyists want. There is no way a public option will work if providers will not participate, and there is no way a public option can bring down costs unless it holds the payment power of budgets and the power of size. If a public option is part of the bill I see it basically neutered by Congress which will limit it’s size, power and budget – It will end up a useless joke and just another failng health option. Medicare should be the public option for all as its size and budget gives it power, but seniors will not put up with anything that threatens them not getting what they want, when they want it.
    We are starting to see the evisceration of this “reform” as “Blue Dog” Democrates (whose constituents need healthcare more than most) worked out a deal for their support that exempts small businesses with payrolls up to $500,000 from coverage mandates and it allows providers and hospitals to negotiate the rates charged by a public health insurance option, and the legislation leaves the door open for states to set up privately run insurance co-ops. There will be no power in a public option to lower costs, it will turn out just as expensive as the rest of healthcare as we know it.
    If Obama has a deedper strategy then I’d like to see it. Right now he’s showing NO leadership as he continues to back down on his original goals for health reform. Look for him to abandon his loyal followers and sign whatever piece of junk is put before him this year with a hollow pledge to improve it.

  6. July 22, 2009
    To whom it concerns:
    As a healthcare provider since 1972, I have seen many changes in the system. The biggest problem is that our elected public officials have created so many legal requirements and have created so much paper and electronics processing work just to get paid that I have gone to a cash and check payment only system. I no longer care for patients who want me to bill any third party payer. This means welfare, workers comps, auto accident insurance and HMO’s. If patients want my services they have to pay me following each office visit. They have to go through the hassle to get reimbursed by their third party payer on their own time and expense. However; I also gave up on auto accidents. Having to take time to process all the documents to prove that a patient needs my services and go to court to defend the patient and not get paid for my time, it is just easier to refer the patient out to another doctor who enjoys this headache.
    I recently asked a retired attorney what the process was to get a new bill created so that it can be voted on. He said that the elected politician has his aids draw up the bill and then he or she reviews it and then sends it off to a legal department where it is turned in to some legal text which no one can understand.
    In this process that bill can be altered by the aids and or the legal department. So that the original intent of the bill is lost.
    Since AARP represents us senior American, I feel that AARP can get enough retired qualified volunteers to write A total new bill and have VOTE ready and put it in the hands of all our Politician
    Now here is my solution for improving the healthcare system.
    The government should get out of being a third party payer insurer.
    The government should create the laws that would regulate a no-fault short and long term healthcare insurance program.
    All insurance companies & HMO would not be able to sell stock in their companies to the public. Policy holders could be classified as shareholders. This means that they should be classified as non-profit entities.
    The CEO’S of these companies salaries should be no more than twice that of the President of the United States.
    All residents in the United States would be mandated to have the no-fault insurance. If they can not afford the insurance then the state or federal government would assist them by paying for their coverage.
    The states and federal government are already getting revenues from Alcohol, Tobacco and Minnesota care tax on health care providers. This revenue would pay for the low income citizens.
    Here are some pluses for a system like this: the healthcare portion of the auto, home owners, business liability, workers comp, welfare medicaid, medicare and other third party insurance premiums would be eliminated. The resident of the United States would only have one healthcare insurance premium to pay. This would save the US citizen a lot of money. This would reduce the paper processing expense by thirty to forty percent.
    Each health policy holder would be eligible for a complete physical including lab. test so that they can work on a personal healthcare program.
    The healthcare provider would only be paid for the actual time spent with the patient and for the materials used in treating the patient. Also for the time spent on process patient records. The no-fault insurance carrier will not be able to deny payment to the healthcare provider.
    To prevent fraud the healthcare provider and patient would punch a time card.
    It is time to quit add ons to an old worn out vehicle.
    Sincerely yours,
    Dr. Philip W. Hughes, D.C.
    PS: I have already emailed this letter to the US President.
    Also several other elected officials.

  7. The most important part of health care reform is winning – without giving away the store, the farm, the house, and three of the four kids.
    We just did it in Connecticut. With tremendous grass-roots support, we took on the insurance insurance and the Republican Party and our own governor and we won. So it can be done.
    On July 20th, our state House and Senate successfully overrode Republican Governor Rell’s veto of the SustiNet health care reform plan – one of the most ambitious plans for universal health care anywhere. The SustiNet law mandates the creation of a nine member committee to be known as the SustiNet Board. The board, co-chaired by State comptroller Nancy Wyman and State Healthcare Advocate Kevin Lembo, will lay out the steps for implementing a plan to provide health insurance to the state’s 325,000 uninsured and to broaden the range of insurance options available to employers.
    The centerpiece of SustiNet involves making the state employees plan self-insured, then opening it up (with quality care and sliding-scale affordable rates) to: the uninsured; Medicaid recipients; small business employees; nonprofit employees; municipalities; and individuals who have unaffordable or inadequate employee –sponsored plans.
    According to health economists Jonathan Gruber of MIT and Stan Dorn of the Urban Institute, SustiNet will return $2.80 to employers and employees for every dollar invested by the state.
    In the insurance capital of the country, with a Republican Governor, a broad-based coalition of small business owners, providers, faith leaders, union leaders, health care advocates and other stake holders beat the odds.
    If we can do it here, you can do it there.
    More about SustiNet is at: http://www.healthcare4every1.org.

  8. Rick,
    Expensive, budget busting, care disrupting computers are not needed to yield CER results proving that not every patient undergoing colonoscopy needs a biopsy, nor does every patient with chest pain need a nuceeler stress test or 64 slice CT.
    Perversions promulgated by government and insurers instigate the gaming of the system.
    Health care reform will not be sustainable unless the doctors gain something from putting up with the heaps of bulldung.

  9. Up to 1/3rd of current US medical interventions are useless or dangerous.
    That, my colleagues, is the issue and wherein lie the solutions.
    -Honest and objective comparative effectiveness research (CER)
    -Convincing the duped and swindled US public that “more in medicine” is not always better
    Dr. Rick Lippin
    Southampton,Pa

  10. “A public option will allow competitive and impartial introduction of the tools required to drive these costs down. The public option is the pathway to reversing the perverse incentives of the status quo which push costs of care and its coverage ever upward.”
    Great, then let’s see Obama institute these reforms on the public option we have right now (Medicare), rather than embarking on a risky and expensive remake of the rest of the healthcare system that the government doesn’t already control. I’m sure that once the Big O and the Dems have demonstrated their success at this, the public will have no problem accepting their other proposals.
    Of course, if they fail, bye-bye Obama! Bye-bye Dem majority! The seniors will see to that.

  11. Actuary – Yeah I fail to see how any of the largely terrible legislation that is coming out of the 3 version of the House bills (even with the public plan) are really going to control costs in any meaningful way including the public option as currently being advocated in the legislation passed by Rengel’s subcomittee. It just adds more fat to the fire largely.
    There a few decent cost-control ideas here and there (e.g., Kerry and others in the Senate on taxing high-end plans) might act as more of a natural break in the interim but nothing comprehensive.

  12. “The best informed experts agree that a public option will drive down health care and insurance costs,”
    The statement is patently false, unless one counts Nancy Pelosi and the like as “experts”. A government-run insurance plan has nothing to do with driving down health care and insurance costs.
    “A public option will allow competitive and impartial introduction of the tools required to drive these costs down. The public option is the pathway to reversing the perverse incentives of the status quo which push costs of care and its coverage ever upward.”
    Nothing could be further form the truth. If anything, the government run option will exacerbate the problem of cost shifting.
    “Unless he presents a specific proposal with a public option and fights hard for it, Obama will be seen correctly as a politician, not a statesman.”
    No, he will be seen as a thoughtful leader who realizes that adding a government run plan is the worst part of any “reform” scheme.
    “It’s a show down between government and the citizenry.”
    That is true.

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