Tag Archives: healthcare

Obamacare but who cares?

This week I saw two interesting things that have driven me back to the blog: 1). Healthcare.gov did not spiral down into a political story. It somehow stayed relatively factual and 2). Everyone missed/is missing the point.

To me, this isn’t about public healthcare, President Obama’s leadership or the government being able to handle a major website.  Though all those things are true especially in the short term, these outcomes – ineffective launches, partial solutions/partial failures, and discord in addressing problems – are symptoms of a larger problem.  We, the royal we, all of us, do not want to have to put in the work required to solve problems, to get things right, to actually implement positive change (and not just change for change sake).

Our expectations about work, timing and sacrifice have so drastically changed as a result of technology that our perception of public policy is now totally unrealistic.  We want complete and beneficial solutions and we want them immediately.  We elected President Obama in the midst of a financial crisis and two wars but then pretended like that wasn’t a big deal and he should have us out of trouble in less than a year. Two or three years tops.  I’m as guilty as the next voter of unrealistic expectations 6 years ago.  The difference, I think, is that somewhere along the line I realized it.

Let me use Healthcare.gov as an example.  Throughout the last week or so, we’ve heard a series of complaints (larger issues than just a crashing website) – Obamacare was a bad idea, government cannot do “big things,” this is going to continue to fail now that the launch failed.  What we’ve forgotten is that the private marketplace wasn’t doing a great job prior to this attempt.  Healthcare was expensive, limited in its coverage and exclusive to certain types (or classes) of people.  So, in this era of quick fixes and high expectations, we’ve conveniently forgotten that one reason we had to resort to Obamacare was the private market failed.  Furthermore, we don’t know the government is going to do it well or even right.  Public policy is, by nature, trial and error.  But is that a reason not to try or to give up on Obamacare?  If so, what’s your idea? What’s a better idea?  Returning it to employer-based private healthcare returns us to a system of inflated costs, ballooning treatment, no prevention to speak of, and many of the most sensitive (the poor, kids, poor families with kids) left without help.  We’ve seen the private market fail, in some cases spectacularly so, in recent years.  The mortgage/financial crisis comes to mind. The point is not which is better because these are not mutually exclusive.  The point is where do we turn when we have a problem? How do we approach solving society’s big problems? I’ll try to stick to the issue de jure.

For those who complain the uninsured or underinsured is a made up problem and the private market can handle it, I have a quick example to the contrary.  A young woman who wants to start a family requires special medication in order to have a healthy pregnancy. Fair enough.  Other than the pregnancy, there are no major health concerns and the medication is temporary just until the pregnancy is considered out of the danger zone (in other words, you can start telling your friends).  As a result of temporary medicine, this woman is uninsurable in the private market.  Yup, preexisting condition.  But she’s not taking the medicine anymore? Get this – she might get or choose to get pregnant again, and if that happens, she may need the medicine again, and the medicine is kinda expensive, but will be required by the doctor should a pregnancy occur, and therefore the private health insurance does not want to risk the cost and will not cover the woman.  Forget that chain of “ifs,” and just look at the decision itself.  An otherwise healthy woman who has a family, provides for them and creates stability both in the community and in the insurance pool is rejected because of the helpful (temporary) medicine used in the early stages of conception.  Makes sense from a business sense, right? Obamacare says this person must receive healthcare and cannot be turned down.  Am I saying that this hypothetical alone is sufficiently evidence that Obamacare was the right decision or policy choice? No. Not at all.  What I am saying is – challenge! If you argue that Obamacare is a bad idea, fine. What’s your idea?

My guess is that someone out there, some health insurance executive or some other experienced veteran of the healthcare industry already knows what the solution is (Obamacare or otherwise) but for a variety of issues – cost, political climate, feasibility, etc. – the solution is not possible right now.  Ok. Then, we’re back to square one.  Which brings me to my original point, this is serious business.  We cannot just expect that we can create an “exchange,” pressure insurance companies into it, throw together a website, and get the right balance of people in order to lower costs and achieve broad healthcare offerings.  It takes time and commitment.

Nothing in life worth doing is easy.

I always use this example when talking about religion, but it fits for public policy too.  Why should being religious or being devout be easy? Working out and staying in shape isn’t easy.  It’s tough. It requires discipline and dedication.  Education isn’t easy.  It’s long, expensive and challenging.  A college degree, graduate degree or professional school degree is an accomplishment and educated workers are compensated accordingly because it’s valuable.  If medical school were easy, how much would you trust your doctor?  Ok, ok, you get the point.  For some reason, we don’t hold politics in the same esteem.  We just assume that the President, Congress and others should just “get it done.”

We, the royal we, all of us, need to roll up our sleeves and get to work.  Similarly we need allow our politicians the same freedom.  When they don’t, we have to be paying enough attention to hold them accountable.  But that’s not gonna happen, is it?

Not only do we not hold them accountable when they shut down the government and spout useless rhetoric (see the Tea Party, Rep. John Boehner, Sen. Mitch McConnell), but we also do not understand when politicians do not take us (the voters) seriously.  They know that we’re not paying attention. There’s no incentive to work hard or get things right.  The only incentives are soundbytes and re-elections.  We don’t like when it requires hard work, when the solution is complex and when it will take years (a generation?) of discipline to correct systemic problems.  If we don’t have the discipline to pay attention and hold public leaders accountable, why should we expect they’d stay disciplined to address these problems?

My take is this is part of a larger cultural issue, of which I’m just as guilty, that we talk a good talk but we can’t walk the walk.  I’m doing it right now. I’ve written this blog post and that’s as far as my observation or passion will take me.  I’ve got a job, family and limited time (just like everyone else) so I cannot take on the Washington establishment. I cannot try to change people’s minds about what government can do and what leaders should be or could be.  Why? I’m having trouble figuring out how to get paid to do it.  Until I can, I’ve got a regular job to go to and try to make enough money to pay for the mortgage, health insurance and student loans.  There is no incentive for me to take this on.  I’m busy.  Is Obamacare working? Is it not working? Who cares? Nothing is gonna change anyway…right?

Look. I’m not trying to be a Debbie Downer here.  All I’m saying is that we have no one to blame (see Obama, see Congress) except ourselves.  We maintain a double standard for public policy choices. These unrealistic expectations make it seem that things which are true in our own lives (valuable achievements are difficult and take time/discipline) somehow are not true in Washington. Yet at the same time, we do not have time or resources to get involved.  Where does that leave us on Obamacare? on public policy generally? What does it mean for “big” problems facing our generation?

I don’t know.  I’m still working on that.  But if I figure it out, I’ll let you know.  Hopefully you’ll be able to spare a minute.

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Why Big Government is Too Small

In thinking about how our government handles problems and policy, I’ve come to realize our government isn’t thinking big enough.  This is made even more relevant this week as President Obama announced a reengineering of NASA’s space program. Obama shifted the focus from the traditional manned space shuttle travel to scientific development here on Earth and deep space exploration.  This got me thinking about why the federal government is not doing more “strategic” planning or high-level planning in all areas of policy.

For the most part, the government is thinking too small, too personal and too individualized.

Our government has narrowed its focused down to the individual level to such a degree that the federal government is literally bogged down in people’s personal lives – sending checks, monitoring students’ test scores, and generally providing daily services.  As a society, I think we allowed this to develop because it is understood to be what’s best for stability and our most vulnerable members.  What we really did was shrink the government down so that it is no longer built to manage macroeconomics, nationwide industries, natural disasters, regional unemployment, climate control policy, national defense, regulate or develop long-range fiscal strategy, focus scientific research and anticipate crisis.

Big government shouldn’t mean providing more entitlement programs and becoming more closely connected to our private lives and bank accounts.  Big government should mean the exact opposite – high-level government.  BIG government. Instead of reaching out and “touching” as many citizens as possible, the federal government should be the parent company of social services, the “Board of Regents” of the educational system and the referee when it comes to social controversy.

You’ll often hear Republicans complain about “big government” and I suspect they mean width.  GOPers fear government influence getting wider and wider into a variety of new industries and increasing power (which usually means increasing spending and taxes).  Democrats, and liberal economists like Paul Krugman, see government as a tool used to solve sociological and economic problems.  As a result, it is natural they would broaden the scope of government influence.

But I think everyone is focusing in the wrong direction.  Government needs to get bigger, not wider.

Our entitlement programs have become really shortsighted.  It’s like the old phrase, “Give a man a fish and he’ll eat for a day; teach a man to fish and he’ll eat for a lifetime.”  Similarly, why can’t the government be in the business of teaching the people?  Instead, why do we continue the expensive and short-term policy of giving out fish?

Despite what it sounds like, I didn’t start this post with any smaller government, lower taxes agenda.  It just does not seem to make sense in a country this size with the diversity of industries, geography and culture to be trying to manage the daily lives of any portion of the population. I submit the country is too large and too diverse to continue to attempt personalized government on a federal level.

In an effort to make this clearer, let’s take a look at some examples:

Healthcare. Instead of President Obama’s $980 Billion healthcare reform, the Obama Administration could have taken a program like the one in Massachusetts, packaged it up and marketed it to the states.  In this way, it’s not the federal government mandating anything, but acting as a solution facilitator and passing good ideas between the states.  There are many areas that we allow states to manage individually – medical marijuana in CA, gay marriage in Vermont, and gun control in TX, just to name a few.  If we become more comfortable with this approach, we can make a more efficient, cheaper and freer society.  In 1932, it might have made more sense to treat the entire country exactly the same, but the truth is that the country is much more regionalized and diverse than the government can handle.

In this scenario, the government wouldn’t be in the personal mortgage business (Fannie Mae) but rather governing and regulating the entire finance and lending industries.  I understand that it’s easier to guarantee home ownership by establishing government control all the way down to the individual level; however it significantly limits how much the government can manage simultaneously.

In an effort to combat social ills and protect our country’s most vulnerable, we’ve gone far afield from what the government is actually good at and is reasonably capable of doing. Should society’s problems and our country’s most vulnerable citizens be the priority? Of course. Using the federal government to mandate a standard or establish the available options to government agencies dealing with these problems means the standard will be too high for some, too low for others and more than likely mediocre for everyone else.  This produces inefficient and less effective results.

Is it possible to rethink the federal government as a high-level manager across the country as a whole? The government is in the best position to focus on the issue mentioned earlier.  By incentivizing and regulating, the government can get bigger and alleviate some of the practical and financial strain, which threatens to grind our current government to a halt.

Liberals can embrace the expansion of the government’s management and vision; conservatives can embrace an increased trust in the role of states.

Raising the bar of the federal government’s focus, attention and influence is a big step.  A few years ago, I would have said it’s an impossible step.  I would have said people reject change and would be unwilling to risk the stability of their attentive federal government.  Today, considering the economic collapse of 2008, the rise of the Tea Partiers, and a growing concern about long-term strategy in America, I think it’s more likely than ever that we could change directions.  But which direction are we headed?

Fact or fiction: Bipartisanship impossible in healthcare bill

My mom and I were talking politics this weekend and an interesting point came up that I thought I’d share – the tension between bipartisanship and re-election.  I was complaining that the Republicans gave up the chance to try to influence or shape parts of the healthcare bill by taking the “repeal” position and requesting the White House “start all over again.”  My thought was that if you know that a piece of legislation is likely going to be pushed through one way or the other, why not try to be involved in the process and get some beneficial clauses or provisions added?  It would essentially have been what Senator Nelson and Rep. Stupak did within their own party but the Republicans could have negotiated certain aspects of the bill and allowed it to pass with greater (or any) bipartisan support.  It was no secret that President Obama was going to make sure this bill passed, why not try to trade a vote for a role in a certain section or provision?

It was my contention that the Republicans were unwilling to trade their vote for a compromised bill because they were afraid to go back to their districts having voted for this bill.  They didn’t believe they could go back to their constituents and explain that they voted for the bill in exchange for some language/provisions protecting the middle class or small businesses.  They assumed, perhaps correctly, that they’d return home to a campaign based solely on a yes-vote for healthcare and lose.  So, at this point, I was blaming the media and the voters for not being reasonable enough to allow this type of strategy without taking it completely out of context.

We’ve reached a point in American politics where a Congressman cannot explain any sophisticated strategy or thought-process with the voters.  I think that it’s sometimes necessary to vote for things like this healthcare bill from a tactical or strategic position.  Meaning, you’re either trading certain language in the bill for your vote or you’re trading your vote for consideration of a future issue that will be coming up in the near future.  The media, and party loyalists, will brand that person a traitor or flip-flopper and they’ll lose the next election.

My mom had a different opinion.  She said that Obama and the Democrats said they wanted bipartisanship knowing that there was nothing on the table that the Republicans could work with or vote for.  Essentially, the Republicans tried to make different offers but none were in the areas that the Democrats wanted; therefore, the Democrats were able to claim bipartisanship and blame Republicans when it did not happen.

This is a good point.  Is bipartisanship even a reasonable goal on something that cuts to the heart of each party’s values? Perhaps the Democrats were banking on the fact that the Republicans wouldn’t be able to find any way, strategically or politically, to support this bill.  They knew no Republican could find a way to support it and thus it was safe to beg for bipartisanship.  It’s a little cynical but easily could be true.

If it is true, however, why didn’t the Republicans do a better job of showing the American people all the ideas they had in the area of healthcare?  I did not hear them advertise or publicize many counter-proposals or areas where the healthcare bill could be altered to make both parties happy.  Rather, I heard more high-level arguments centered on the fact that Americans do not want this bill and they should repeal the bill or start the process over.  In my opinion, that was not helpful for anyone because the bill passed without much input from anyone but those within the Democratic Party.

If it was somehow impossible for the Republicans to find any way to negotiate anything in this bill, they did a poor job of representing that position to the American people.  They seem to have come out of this process, once again, as the party of “No.” Granted, if they bill somehow fails or does not impact healthcare access or prices in a significant way, Republicans can take credit for their strategy.  This is a big risk and also involves counting on our lives getting worse to be successful.  Not a great goal for a political party that is supposed to working for our betterment.

If the Obama administration somehow orchestrated a process that was able to have his cake (passing the bill) and eat it too (making the Republicans look bad), that is also not a great goal for an administration, which was supposed to represent a new way of doing business.  Not that previous administrations have not done that, but this one was supposed to be different.

In short, either the Republicans won’t or couldn’t be involved in this bill.  Whichever it was, it is an all to familiar place in American politics.  I’m sure loyal Democrats reading this are thinking, “But this is what the Bush Administration did too” and “the Republicans were just obstructionists here.”  Loyal Republicans are thinking, “Obama was disingenuous and never wanted bipartisanship” and “this is the end of democracy as we know it.” It is likely that however we approached the healthcare debate before it passed will color our opinions after the fact.

Regardless, I was hoping that we were moving in a direction beyond these types of battles and that Obama would discover a way to push Washington beyond petty politics into real discourse.  Whoever is to blame, it does not appear that that much has changed. Yet.

It’s not business, it’s personal

One of the themes that has been coming up a lot in podcasts, articles and in my mind is how the general disregard for the implications of our decisions is dangerous.  It was most visible in the mortgage industry during this current economic crisis.  From the lenders on the front lines to the bankers dividing and selling derivatives, very few people stopped to consider the individual decisions and overall impact of their actions.  It’s not just the financial industry either.  This has sparked many questions about politics, economics and even law.

First and foremost, I am interested in the relationship between theory and reality. As people question our healthcare system, tax system and even capitalism, I realized that these are arbitrary systems we’ve chosen and organized to best solve our country’s problems.  While many protestors or extremists try to convince the rest of us that one economic system (say, capitalism) is more moral or “right” than another (say, socialism), in reality, both are just practical systems implemented to try to balance individual prosperity and societal interests.  Granted, many of us have preferences between political and economic theories as well as believing one theory to be the correct and the other to be the incorrect solution.  We’ve forgotten there’s a distinction between correct and right.  It feels like since WWII or perhaps, the Cold War, we’ve transitioned into a political culture, which has replaced correct/incorrect with morally right/wrong.

Simultaneously, we’ve become less interested in a personal view of politics and economics.  By analyzing if a theory is correct or incorrect at a national level, we’ve lost sight of whether it’s right or wrong at a personal level.   This is starting to sound like I’m preparing to make a case for socialism or something else crazy and dramatic.  Instead, the point is that when we lose sight of people (and people’s real lives), we lose perspective and make choices just for money.

What banks do, what real estate developers do and most importantly what politicians do affect people’s lives.  I don’t think the phrase “it’s not personal, it’s business” applies anymore.  We’ve come too far and built too much to be squandering opportunities to improve lives.  At this point, I find it hard to believe Congress is still concerned about which theoretical system of governing is superior.  More to the point, a decision will improve or threaten someone’s life versus adhere to a certain theoretical system.  We’ve become so divided in today’s political culture that we’ve lost personal perspective in favor of defending theoretical political systems.

Over the past few years, this dichotomy has continued to challenge me becoming more apparent in law school. If we’re making choices that are theoretically proper but harm each other either economically or practically, we’re missing the point.  Too often, I think many on the right are willing to risk harm in favor of a theoretically correct system.  On the other hand, I think many on the left sacrifice rules and rationality to force practical good.  As with most things, the solution is probably somewhere in between.

While I’m still not prepared to offer concrete policy solutions, I think we should all spend a little more time considering both our own decisions and the impact of those in power.  It seems that one of the greatest challenges of a politician is the balance between the macro and the micro.  For example, Obama needed to relegate lower class, practical needs by focusing economic relief on banks and financiers yet trumpets the practical needs of the same individuals when prompting much-needed healthcare reform.  He used a theoretical approach on the economic crisis and a much more practical approach on healthcare.  I’m not sure which is better and whether or not he’ll ultimately be judged successful.  I am sure that if we lose sight of the practical – food, shelter, education, healthcare – we’ll have nothing left to argue about theoretically.

So, if abiding by our theoretical choices in capitalism risks regular people’s practical lives, the choice better be worth it and clearly explained to those asked to make a sacrifice.  Ultimately, I’ve found myself becoming much more pragmatic and interest in how political decisions affect real lives.  I still have ideas about what works and doesn’t work theoretically but am much more interested in results.

Maybe one size doesn’t fit all

Generally speaking, I tried to post ideas, which are fully conceived and developed a bit rather than whims and daydreams.  However, I think this one is better posted without too much consideration.  I had this idea the other day that we’re approaching many political problems and issues from a national, federal government perspective.  One reason that I think some of our problems are so complex is that we’re taking our republican form of government and attempting to apply solutions across 300+ million people.  I think we should begin to rethink our one-size fits all approach.

I know that state’s rights is a traditionally Republican issue and is often seen as the solution to a large, centralized federal government.  However, I’m not making the argument that we all embrace the GOP’s state’s rights argument which is also often mistakenly applied as one-size fits all too – small.  Rather, I’m suggesting that we rethink the way we embrace and develop solutions.  The federal government often tries to take over all major policy ideas because it can throw the largest amount of money and (presumably) make the biggest impact.

The truth is that I think many people are Democrats locally and Republicans nationally.  What I mean is that we understand the value of government infrastructure and services but we don’t want taxes and government control to go too far.  We’d like to spend money on government services that actually work and don’t mind taxes when we see them working.  But many people, even Democrats, are wary of a growing, spending federal government. The problems that the Obama administration is attempting to address are serious problems and traditionally the only way to get people to take them seriously is using the power of the White House.  But the truth is that Americans often feel torn between the moral value in covering (and helping) millions of our neighbors without healthcare, for example, and the intellectual understanding of how much it costs and the fiscal danger we’re passing on to future generations.

What might work – and like I said before this is a very new theory for me – is to give more responsibility to the states to tax and spend for direct government services.  This way, the states can better address local and regional issues and citizens can feel a more direct relationship to their tax dollars being spent.  Also, a smaller federal government avoids waste and inefficiency (slightly better than they do now) and can oversee more of the process/regulation than the actual direct services.  Our country is too diverse and many problems too complicated to try to solve them for everyone in one document or one piece of legislation.

This also applies for social issues.  Obviously many progressives and libertarians would like to see the federal government compel the entire country to create, protect and enforce social freedoms.  But the truth is, we’re diverse and there are culturally differences in our society.  Though it’s not the best solution for social liberals, there would likely be greater cultural advances (in the end) if states could push the envelope and create mini-examples to the rest of country on issues like gay marriage, legalizing marijuana and other issues.  We’ve seen this happening on the social side and I’m considering applying it to the public policy side of governing.  This doesn’t require a one-size fits all approach but does allow states to compete against each other and a progressive state could become a national example on some issues but wouldn’t require national politicians to negotiate away a legislative solution based on an amendment about a social issue, like abortion or something.

We couldn’t allow states to violate the Constitution, obviously, and we’d want to protect rights of ALL American citizens equally.  However, we’re taking the one-size fits all approach to national politics and complicating it even further because politicians have to protect themselves on social/controversial issues during a legislative debate about the budget, healthcare or even more unrelated topics.

Maybe we’re all a little more Republican and Democrat than we thought, just applying it differently to different problems.

My thought is the federal government sees the potential to take the biggest risk in order to achieve the biggest rewards, and I like that style.  Yet, that approach is creating a greater divide between The Parties and fueling stalemate on issues that seriously need attention.   It was just a thought on how to better free up the federal government, link Americans closer to their tax dollars and possibly get solutions into our communities faster and more appropriately.

NOTE:  I’m having trouble distinguishing between republican – the governmental structure and Republican – the political party.  There was some inconsistency online about when to use the capital “R”.  So, instead of writing “Republic”an or republic-an, the way I have in other pieces on here; I’m going to use republican to denote the government organization and Republican to mean the political party.  If I have this backward, please let me know.

America’s overreacting and I’m still walking a mile

America needs to regroup and walk a mile.  The politics of over-reaction have come to dominate both the cable news and political landscape in this country.  Just when I thought Obama’s style might slow the growing tide of divisiveness and “politics of fear,” the opposite has occurred.  Everything is a crisis – housing, healthcare, the economy, education and Wall St.  We’re no longer using homey clichés like “when life hands you lemons…” or “every challenge is an opportunity,” but rather the more grandiose phrases like “this is a turning point in history.”  Granted Obama’s campaign added to the politics of “the moment,” but I think we need to realize that not every issue is tettering between America’s failure and salvation.

Obviously, this isn’t just politically.  The Biggest Loser, Extreme Makeover and The Bachelor all suggest a message that you can change everything about yourself, your life or your world in 6 weeks or less.  Life’s just not that easy.  Without getting too personal, a few months after college graduation I was tipping the scales at 300 lbs.  It was then that I saw a picture of myself, was too embarrassed for words, and agreed (with the help of a friend) to run a 10-mile race.  As a former athlete I didn’t mind the hard work or discipline but I knew it would still be torture.  The first day, I couldn’t even jog and was forced to walk a mile.

America needs to start by walking a mile.

Eventually, I trained and finished the 10 miler on my way to losing 70 lbs.  I’m telling you this in the interest of long-term discipline and measured expectations.  I could never have begun the process by freaking out and trying to lose 70 lbs in a week.  In America, we’re taught to do everything bigger and better.  We try to do everything to the extreme – quicker, higher or “larger than life.”  We’re unwilling as a culture, country or as politicians to walk a mile.

We spent 25 years cultivating ever-increasing expectations and making promises about wealth and security.  Now that it’s turning out to have backfired on a global stage, it hurts and people are angry.  However, I don’t think the solution is to change our whole system or implement some extreme countermeasure.  We need to regain our sense (I’d say common sense but there’s too many blogs and podcasts already claiming to the last stand of common sense).  We can do something to improve our lives while preparing for the future.  And it doesn’t involve “impeaching the President,” overthrowing the government, becoming “socialists,” or using government to take-over/bail-out any entity which isn’t popular in the press.  We could walk a mile (and maybe watch what we eat too).

America’s waking up with a hangover and claiming “I’m never going to drink again.”  When it’s much more appropriate and successful to instead say, “I’m going to watch how many drinks I have and make sure to have some food and water along the way so that this doesn’t happen again.”  Too much too hope for? Perhaps.  I don’t understand why we’re not capable, as a collective, to think the way an individual or family might.

Our politicians and The Parties have convinced themselves that the only way to get attention and fund raise is the politics of fear and overreaction.   Thus, here we are. Fueled by cable news and fundraising.  I’m not asking for Democrats and Republicans to dismiss their core beliefs and suddenly sit down like the Biblical lion and lamb, and that’s just the thing.  Somehow the two parties working together on policy has become akin to the second coming of Jesus Christ.  It doesn’t need to be.  Why not agree to figure out solutions to our problems? Bargain, compromise, and negotiate.  But don’t pretend that the next press conference or a certain piece of legislation is the end to democracy and life, as we know it.  We can do this one step at a time and slowly get back in shape.  But you’ve got to start somewhere.  Let’s all walk the mile.