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.