Tag Archives: public policy

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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Trust Me

So, I had been writing a post that addressed the recent lapses in character by New York’s political characters – mainly Paterson and Massa.  Yet, I realized that not only is this not a new topic, it’s not even new to New York.  What bothers me is the frequency of personal and professional misjudgments in today’s political arena and how it affects legislating.

I’m sorry but the first half of this post is about a week late and heavily focused on New York. Gov. Paterson is being implicated in everything from poor leadership skills to obstructing justice.  I’ve regarded him as a terrible governor based on my determination that he’s disconnected from reality, mismanages everything including the media and does not provide workable solutions at a crucial time for the state.

And have you heard about this former Congressman Eric Massa? If you are a fan of Saturday Night Live you may have seen Jerry Seinfeld join Seth Meyers for a bit on SNL’s Weekend Update titled “Really?!? with Seth & Jerry.” They corrected mocked a ridiculous situation where Rep. Massa resigned his office only to reveal inappropriate, yet apparently not sexual, relationships with younger staff members.  You know the usual “I wrestle and have tickle fights with my male staff members that I also live with” type of story.

For whatever reason, every time these stories come up I get frustrated.  It’s like steroids in professional baseball.  No matter how much I tell myself not to let it get to me and there’s nothing we can do about it anyway, it gets under my skin.

Granted, many of the political stories are personal issues involving infidelity or sexual relationships.  I’m sure politics is not all that special when it comes to this.  Executives of powerful companies, movie stars, professional athletes and other high intensity/high reward occupations have a large number of these stories too.  In most cases, those individuals have not asked for the public’s trust.  Maybe that’s what bothers me, I’m not even sure.

Whatever “it” is seems to go to character and integrity.

Which brought up two questions for me: does personal integrity for a politician matter any more or less than for a CEO or movie star?

Second, and much more relevant to this week, if we cannot trust them to keep their promises to their wives or to their constituents, can we trust that they’ll follow through on policy or legislation?

I do think personal integrity matters in politics.  Because it matters in life.  Just like you want to trust your accountant, business partner or doctor to be honest and keep their word, we want our politicians to as well.  The only difference is a business partner or doctor can have affairs without it necessarily affecting their other responsibilities.  Can a Congressman, Governor or President? Many people after the Clinton-Lewinsky scandal of the late ‘90s seemed to say yes.

Assuming that’s true, it brings up a larger question that is relevant to this week’s healthcare reform bill. Apparently, the White House decided that passing an average or limited bill was better than no bill at all.  I’ve heard many commentators like Krugman and others claim that “we’ve” got to pass something and “we’ll,” meaning politicians or the people that elect them, go back and fix it later.

When I first heard this and wanted to write more about it, I simply wanted to post the following:

Is it better to get the legislation right and pass a good law? Or write a limited and perhaps flawed bill but promise to fix it later?

My reservation about this healthcare legislation is trust.  I’m not convinced that politicians really change that much over time and I don’t trust them to go back and fix inaccuracies or flaws in this bill.  Overall, am I glad we’re moving toward a policy that attempts to bring relief and help to people who are suffering or being taken advantage of by insurers? Yes.  Do I trust Congress not to do more harm then good when trying to negotiate and pass this stuff? No.

Please don’t misunderstand.  My goal is not to say that some politicians have personal problems and thus we can’t trust other politicians to pass good legislation (although it sure looks like that’s what I’ve written).  On the contrary, my goal is test my own expectations when it comes to our elected officials and gain a realistic perspective on what we can expect from Congressional promises to mend healthcare in the future.

I’ve always been a supporter of action over inaction and I think one mistake the Republicans made recently was to become the party advocating inaction or non-action.  Public policy needs to be tested, it needs to be attempted and most of all it needs to be trusted.  I think a lot of people, generally, trust the President but not as many trust Congress.  In fact, my political science professor used to say that approval ratings for individual Congressman are high but for Congress overall are extremely low.  The general notion of politician is not one of trust.  I guess I just wish that were more of a concern than a generally accepted statement.