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The Great Healthcare Reform Debates:Key Elements, Complex Causes, Difficult Problems, Policy and Partisan Politics
By Dave Livingston. Dave is a management consultant with almost 30 years of experience with analyzing complex business problems and developing solutions and new businesses. He blogs on public affairs at his blog Parts to Wholes: the Socionomic Systems Nexus ( http://llinlithgow.com/PtW/ ) where he attempts to apply that toolkit to current affairs and public policy. He also brings a background in economics, politics, current affairs, international relations, history and philosophy to the table. The work you read here is the result of applying systems analysis (hence “parts to wholes”) to complex problems in Political Economy and Public Policy.
Introduction
Healthcare is the fastest growing and, by some measures, largest single sector of the economy. It’s the fastestgrowing because it’s the only sector where costs have been growing at an exponential rate for almost twodecades. The implications of that are enormous, for each individual, for every business and for the overall healthof society as well as the long-term viability of government. Despite all these serious challenges, which we’ve beengenerally aware of the issue of Healthcare Reform has been sadly neglected because of the size, complexity,interest group concerns and partisan politics that have swirled around it for decades. Yet, despite of all that weare closer to real and substantive changes than we have been since 1965.Because Reform has been so contentious politically, because it touches so many parts of so many peoples livesand livelihoods and is such a major part of the economy there’s been enormous anxiety and a lot of partisanposturing and positioning over the last several months. In the process very little has been said that has madeclear what is going on simply and clearly enough for either concerned citizens or interested stakeholders to havea clear understanding of all the many moving parts and complex machinery involved. This is our best attempt atsurveying the landscape, collecting reliable information and presenting conceptual and analytical frameworks thatmay help you understand what’s going on and the potential impacts, whether you are a private citizen, aparticipant in the Industry or involved in it as an investor or other interested party.Healthcare is huge, now about 14-17% of the economy. When we first got introduced to these concerns in theearly 90s it was 6% and growing rapidly toward 10%, which worried everyone then. Now it’s likely to grow to 40-50% on current course and speed. Which is of course unsustainable. In fact healthcare premiums have risen sofast that they’ve gone from about $8,000 to $15,000 per family and are headed shortly for $25,000. In the longerterm without deep structural changes out of control costs present a real danger of bankrupting the country.At the same time the US spends 2-3X what the other major developed economies do, appears to get about ½ asmuch value on a wide range of performance measures and is the ONLY developed economy that exposes itscitizenry to catastrophic risk of financial failure. Rising healthcare benefits have also been a primary cause ofstagnant wage growth and have seriously hampered the performance and competitiveness of American business.In short there is no single person or interest group who will not benefit in the long run from putting Healthcare on amore viable and sustainable basis.There are however an enormous number of complex moving parts linked together in a great many relationships.That makes analyzing the challenge very difficult for its own sake. At the same time the debates over Healthcarehave been extremely rancorous and partisan, representing issues of political advantage and leading to majorfabrications and distortions and exaggerations if not outright mis-representation. At a level that is almostirresponsible and a failure of public fiduciary responsibilities. Normally with a major policy challenge of this scope,complexity and magnitude it’s critical to understand the interests and positions of the major stakeholders asidefrom the intrinsic issues. For Healthcare it’s also essential to understand the political issues and the inter-connections to the Economy. Accordingly you will find us starting with a careful consideration of the political and
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economic realities follow by three major essays analyzing the dynamics of healthcare provision and tying all thepieces together while also taking a look at interest group positioning. Finally you’ll also find a very large collectionof selected readings that are the best we could find to provide backup information and data on all the pointsdiscussed and analyzed.
Table of Contents
Essays
1. Sausage Eating Lizards: Sonia, Spooks, Death Panels and the Pope 32. A Teachable Moment? - Fear, Loathing, Renewal and Futures 83. A Taught/Taut/Taunt Moment: Healthcare Speech, Policy, Politics & Realities 104. Paths Toward Healthcare: Compromise, Consensus or Conflicts? 145. The State of the HC Debate: Rattling Toward Resolution 17
Readings
1. Level-setting: Quick Reads for De-mythologizing Realities 202. Political Positions and Cost vs. Impact vs. Benefit Realities 223. Healthcare Coalition Building: Sausage-making 26
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August 18, 2009
Sausage Eating Lizards: Sonia, Spooks, Death Panels and the Pope
http://llinlithgow.com/PtW/2009/08/sausage_eating_lizards_sonia_s.html Welcome to "Reset World" where we're having to faceup to the last thirty nears of grasshopperian neglect ofvital issues and public policy. This is a post we'vebeen holding in the pending file for too long becauseit's just been one damn thing after another. The badnews is the delay and, perhaps, the amount ofreading materials in the excerpts section. The goodnews is that there's a bunch of stuff to point too. Theworse news is that we're going to be trying to weavetogether a bunch of different threads into a coherentfabric. The possible news is that if we do this beardance you may get something out of it. Justremember though the miracle of the Dancing Bear isthat it dances at all, not how well it dances.Serendipitously this was the 40th Anniversary ofWoodstock, you know the celebration of peace andlove that set the tone for the next 40 years ! Yeah, right. Just not quite the way it was intended. That clip wasWoodstock then, for Woodstock now try thisvidclip of the old surviving hippies (http://www.youtube.com/watch?v=eYKY2lpxMg8) who are now tour guides, and the museum, all selling thevision.As David Clayton Thomas of Blood, Sweet and Tears reminds us inthis BNN interviewit wasn't quite like that. Forone thing Kent State had just happened and people were angry, for another none of the headliners got paid sothey aren't memorialized in the historical videos. For another there was sure a lot of violence in other places and alot of folks who didn't buy into the "it's all different now" message. In fact the Greatest Generation who hadsurvived the GD, fought WW2 and built modern America that Woodstock was so against were just in their forties.Woodstock is now twice as far behind us as their adventures were behind them.BUT...and this is the point...the decisions and divisions wecreated then have been reverberating every since. Have we doneany better? That's not an easy answer btw - the Boomers foughtthe Cold War, 'Nam, dealt with the biggest social changes in ourhistory and changes in our society and economy that werephenomenal, to say the least. How we wrestle with theconsequences of those legacies going forward is going to defineAmerica for the next forty years. How will we deal with our mentalimps - rationally with a sense of decency, commonality and publicinterest? Or pursuing private agendas that put partisan advantageahead of the public good?One final clip, audio, this time from the historical archives of "This,I Believe":Our Noble, Essential Decency. Scifi Master Robert A.Heinlein. (http://thisibelieve.org/essay/16630/ )
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