Health care reform: econo-think, democracy and sustainability

Wendell Potter on Bill Moyers Bill Moyers Journal recently interviewed Wendell
Potter, who spent much of his career in corporate communications for health
insurance giants CIGNA and Humana. Every American concerned about affordable
and quality health care and the American political system should watch it.

Potter went public to tell the truth about how the health
insurance industry advances both its bottom line and its massive political
advocacy against meaningful health care reform.

Moyers asked Potter, “Why is the industry so powerful on both
sides of the aisle?”  Potter’s
reply: “Well, money and relationships, ideology.”

The distinctive ideology Potter mentions deserves more national
dialogue and deeper understanding.

Toffler in his groundbreaking work Future Shock labeled the strict adherence to free market principles
Potter references “econo-think.”

A core belief is that investor profit drives
the material and moral “worth” of products and services, and is the metric of
social progress.

Most Americans place high value on our economic
system with its emphasis on free enterprise, entrepreneurship and competition.  But history teaches there are
circumstances when public interest must be protected against business practices
that damage society, the natural environment or the economy.

Sustainability provides a superior moral
compass that stands in contrast to econo-think, and enables us to recognize
that we live in a society and a natural world as well as in an economy.

The over-arching goal of
is to meet the needs of the present generation without
compromising the ability of future generations to meet their own needs.  This goal cannot be reached if
production and consumption patterns damage social and natural systems in ways
that cause dysfunction.

The costs of this damage—whether from
climate change, escalating costs of health care and its coverage, or job
loss—hurts the economy ultimately and is unsustainable.

As a guide for organizing and managing major
social systems, sustainability holds that “worth” and “profit” often are valued
in non-monetary terms.

Outcomes matter to “sustainability
thinkers”, like good health, a protected natural environment, or, in the case
of governance, policies that advance the common good in ways that protect the long-term
interests of the present and of future generations.  Because these outcomes often require investments with no
apparent short-term monetary gain, they lay outside econ-thinkers’ field of

contemporary version of “econo-think” ideology developed during the 1970’s and
1980’s in response to legitimate concerns about the capacity of American
business to compete in the emerging global economy.

The Reagan
era is when government became the “enemy” and “the problem, not the solution”;
and when a massive de-regulation of business began.  Econo-think became a pervasive and, for some Americans,
exclusive ideology.

Econo-think now
dominates the value system of the production and consumption of health care and
its coverage. These have been industrialized and commercialized.  Costs have skyrocketed because the
over-arching goal is profit.

The social values health care should
serve—quality, compassionate and affordable patient-centered care—have
decayed.  These values are trumped
by econo-think, which emphasizes fiduciary responsibility to investors, not
duty to the health of patients.

likewise conditions the political system. Health and insurance businesses
invest in lobbyists and campaign contributions.  These business interests expect and receive a profitable return
through public policies that advance their economic interests.

traditional values the political system was designed to serve waste away
through disuse.  These values arise
from civitas, a combination of civility, a sense of civic duty, citizenship and
shared responsibility to build a sustainable society.

civitas goes missing from the body politic, systemic failure results, just as a
human body loses its health when cut off from its sources of vitality.

The health
care reform debate with its toxic mixture of money and politics and its
incivility teaches that our political system has been poisoned by fear, anger, and
self-interest wrongly understood.

has lost its capacity to reconcile conflict, to compromise and reach consensus.  People act like angry consumers in a
marketplace rather than citizens in a democracy.

elected leaders and their staffs behave as if their services are for sale.  The migration from public service to
the lobbying corps affirms this fact of political life.

competitive and manipulative marketing mindset of econo-think also dominates
electoral politics and other forms of political persuasion.  Propaganda and the stirring of public
emotion dominate a news media bent on profits.

democracy is not representative or deliberative.  A breach of trust in government, business and other major
institutions has taken hold.

We have
lost the ability to share sacrifice in service to the greater good of society,
and of the meaning of calling to a vocation in loving service to humanity.

Many Americans sense
that we have lost our way because we are cut off from the traditional values
that define us as a nation.  A turning away from the present course is demanded.

The central challenge
facing the nation is to reconnect with the time-worn and proven “first
principles” informing the American experiment with democracy, renew our
founding values, and regain civitas.

The present crisis in
health care foreshadows a deeper systemic failure unless a turning takes place
away from econo-think and to sustainability as the nation’s lodestar.

values of sustainability and democracy form the core of the nation’s founding
aspirations and its means of progress.
Blind adherence to rigid ideologies like econo-think don’t suit
democracy.  They don’t achieve
sustainability, which depends on flexibility and the capacity to adapt to complex
challenges as practicality and necessity demand.

should ask of each other in the fashion of Dr. Phil:  “How is the present direction of the nation working for

Wendell Potter’s example will be followed by many other econo-thinkers as they
answer that question and conclude that their ideology is built on quicksand.

contrast, the combination of sustainability and democracy co-joined by civitas
is built on rock. This foundation is required to build, sustain, and govern a
great civilization.

Larry Arrington is a Florida-based planning and management consultant
and a former county and city manager.
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/.

1 reply »

  1. Informative and intriguing, great post. It suggests that we are mired in an economic mind set that is difficult if not impossible to extract the nation from the current healthcare woes. What is the driving influence to ‘convince’ the players to adjust their underlying goals? Certainly it would seem that simple Gov. ‘control’ or regulation would fall short, because if the large players fail to meet their current econo-think ideological goals, they will jump ship or alter their models completely to maintain this. Perhaps only when facing extinction would many switch to understanding the moral and societal worth of healthcare as a motivator..?
    As physicians, we instinctively pursue our trade with a societal/service motive (ie there are plenty of easier careers), however to support our ability to do this, we have had to adopt a more ‘econo-think’ basis. So begins the carousel..round and round…
    Additionally, part of the dilemma is that the ultimate ‘consumer’, ie the public shareholder or patient, has not in general taken a role in motivating this change either. For example, the societal benefit of keeping oneself healthy or submitting more of their income to healthcare, at times directly conflicts with their personal freedom.
    Anyone have a solution???