Management 101

The health insurance [ne health care] reform debate is fast becoming farcical. There may be public support for reform but the lack of specifics in what the administration is really targeting is a problem; who pays for it and how it is paid for is another. The Democrats initially focused on covering the 40million plus uninsured rather than how the new plans may be better for the 200million plus Americans on existing plans. The CBO cost estimates have fed public skepticism given the economy, banking and auto industry bailouts, the costly fiscal stimulus and growing federal debt.

Leaving the bill writing to congress [presumably to avoid a repetition of the Clinton administration's health care misadventure] has illuminated the acute divisions within the Democratic party, the negligible GOP support and amplified the criticism of the CBO. The lack of support from other parties including the Mayo Clinic and AARP have created real issues to be dealt with. These issues when combined with the creative and repetitive distortions by conservative activists are creating a potential fiasco. The crowning achievement was making a heroine of Sarah Palin by withdrawing "end of life counseling" as a response to her 'Death Panels" comment. How brave our legislators are! These issues are further exacerbated by the poor responses from key Democrats a la Pelosi's "villainous" insurance companies and describing rowdy town meetings as "unAmerican", Rockefellers calling the insurance companies "rapacious". How did we get here?



Obama's essentially hands off management of the reform process has resulted in congress owning health care reform; unfortunately congress is held in low esteem by the American public. Surely the White House [WH] knows the liberal, generous bent of this House? The WH should not be surprised at the dog's breakfast being served up by the House nor the predictable objections of the Blue Dogs once the CBO weighed in? Could any thinking person have expected Pelosi to acted differently? She is after all considered an extremely tribal politician even by Democrats. So, now we await the proposal of Max Baucus' senate committee which will at least will contain a modicum of bi-partisan cooperation.

The poor execution is exceeded only by the poor management up front has gotten the administration and the Democrats where they are today. Since health reform is Obama's signature issue , he needs to be seen taking charge and he may finally be doing that. When he speaks to Americans about health care, it shouldn't sound like policy gobbledygook; forget the 45 minutes of lofty rhetoric in front of teleprompter. Keep it simple; "see John run " speak to both pros and cons, forget the techno babble that so enthralls congress. if you want health care reform Mr. President tell us what it is specifically and sell it. Tell us:

• how will the new plan help the 200 million plus who have insurance be better off , can thy keep their existing plan if they wish??
• can't existing group/employer policies be made "portable"?
• who pays for the new program... surely we are running out of "other people's money"?
• how is a public plan to keep insurance companies honest if the government has already done a cost reduction deal with the big players?
• how do we expect private plans with their need to pay taxes and generate a profit to co-exist with a public plan that will essentially be tax and profit exempt?
• aren't there any cost reductions besides "streamlining" and paperwork reduction? Unfortunately the prose here sounds like...well, we will try harder. This from the government and the congress that gave us $16000 screwdrivers and $32000 toilets.
• what about tort reform or otherwise moderating malpractice insurance?
• what about eliminating the geographic health insurance oligopolies in much of the country?

The president is far more credible than congress. He wants reform; he needs to put his reputation on the line. He needs to tell us what he will support, what he wants. That's management 101.

Health insurance and sausage making

It was Bismark who said there were two things we didn't want to see being made; sausage and laws. This summer we are really lucky- we can watch the manufacturing process in living color for both simultaneously! At summers' end, the challenge will no doubt be to make the distinction in the finished products. For without real leadership, the best we may get is a health care plan that passes for sausage.


It began with health care reform initially focusing on the uninsured and medical cost reduction. Then the plot sickened with CBO estimates in the trillions, concern for cut backs in Medicare/Medicaid, tax increases and fears about a public option. It didn't help that the Mayo Clinic has panned the pending house bill. The areas for decreasing costs in our lifetime appeared limited to less paper work via computerization of records, and amorphous administrative savings. Not much about tort reform, or otherwise moderating malpractice insurance. Not much about breaking the geographic health insurance oligopolies in much of the country. Nothing about equalizing the tax treatment for employer provided and individually owned health insurance plans. Little about making costs transparent. In hindsight, we shouldn't be surprised at the lack of specific cost control substance coming from this congress; look at the battle over 7 F22s', Nancy's airplane upgrade. You really cannot expect the foxes to mind the chicken coop - can you?


With the growing public unease about costs, the public option, and the lack of definition on the likely program, our politicians took the low road; health care reform morphed into health insurance reform and finally as an attack on insurance companies. We are now treated to senior congressional leaders going on about "rapacious", "villainous" insurance companies. Of course we do have the equally inane coming from the other side including ignorant comments about "death panels".

So what's next? Nancy Air will fly our august representatives home for the August recess. Some how the senators will get home also ... again at our expense . The WH will go on the town meeting tour to try and gain public support for reform. There is public support for reform; the problem is the lack of specifics; not very many people are against apple pie and motherhood. People want to know how a new plan will help them; can they keep their existing plan? What is the public plan? How does all this get paid for? Who is going to pay for the plan? Is there any "other peoples' money left? Fair questions that deserve direct answers...not the DC shuffle.

When congress returns, the various sub committees will no doubt finish their versions and begin a reconciliation of the different versions into one for the House and another from the Senate and eventually into one proposed law. The downside of leaving essentially everything to congress is we will wind up with sausage.