National Healthcare Reform Leadership

A new national healthcare system is in the works, or at least a modified one. Which is good, because no matter how you slice it the country needs to do something about steadily increasing healthcare costs, says the CBO.

If rising healthcare costs were a steamroller. . .

In BusinessWeek, Nikos Mourkogiannis proposes that the new system should focus on cutting costs. He also says that, while that is a fairly obvious consensus view, actually implementing it will require prodigious acts of leadership. The general idea is to create a system that ensures the average person will have a minimum level of benefits.

As Mourkogiannis points out, the new healthcare system will not be able to do everything for everyone, it will have to make triage decisions which first reduce costs (and do everything else second). From the White House:

President Obama is committed to working with Congress to pass comprehensive health reform in his first year in order to control rising health care costs, guarantee choice of doctor, and assure high-quality, affordable health care for all Americans.

The fun thing about mission statements is that they often utilize a lot of commas. Giving commas to a bureaucrat is the linguistic equivalent of giving a credit card to a teenager. All sorts of commitments are made with little consideration given to whether or not they can all be delivered. The term "high-quality" has a lot more wiggle-room than "affordable," and the situation demands the focus be on "affordable" anyway, so "high-quality" is really only in there to attempt to placate fears that the healthcare storm troopers are going to drag you off to the crematorium when you reach 65.

Your grandpa ran off to join the circus. Here's his replacement.

High-quality will have to be secondary to low cost. The only reason we need healthcare reform is that our current approach will bankrupt us. So, at a minimum, we have to do the same thing only cheaper. Improving quality would be nice, but it is not the primary driver; cost is.

Now, try explaining that to the people who will cost too much to take care of.

This healthcare reform situation is a good example of a situation that demands attention be paid to systems, innovation and leadership. The system is monstrously complex, implementing it won't work without some innovations that no one's thought of yet, and even then the leadership challenge is pretty much guaranteed to be beyond anyone's capabilities. We (Americans) are okay with the idea that the system can't take care of everyone. We are not okay with the idea that the system will officially not be taking care of everyone because they are officially on the wrong side of the cost/benefit analysis.

That being assumed, what sort of leadership approaches have the best chance of getting people to at least let the necessary changes happen, if not get people excited about the changes?

• "We are working hard for you, but someone/thing else is working against us." Whoever gets saddled with the job of representing healthcare reform can try casting themselves as the plucky, unquestionably-good-hearted hero valiantly struggling against an evil menace. The menace could be immigrants flooding our emergency rooms, greedy HMOs, or just the vast scale of the problem.
  
• "We all know more than you and we say this is a good idea/working." Several large stakeholders in the healthcare marketplace, like the pharm-companies and AARP, have already expressed support for healthcare reform. It could be possible to present a unified front that overwhelms any attempt to claim it's a bad idea.
• "Every alternative is worse, especially doing nothing." Proponents of healthcare reform, like me, have pretty much started here anway. This approach assumes that this will remain the primary tool moving forwards. It could be expanded upon by occasionally adding a new description of just how bad the future will/could get if things aren't done in a particular way.
• "I was worried, but now I see there's nothing to worry about." Instead of the leaders speaking, they could get average Joes and Janes to speak for them. That way the people who need to be convinced could see people just like them being convinced, rather than Ivy-league, smooth-talking socialist puppets trying to be convincing.
  

President Obama's Healthcare Newsconference

The President addressed the nation. . .or at least as much of the nation as felt like watching the whole thing. The ones who relied on soundbites will miss out on the chance to draw their own conclusions, because anyone who uses soundbites or quotes is trying to back up a predetermined point :-)

He said, "I'm the president, and I think this has to get done." This sort of statement is interpreted as arrogance by people who don't like the speaker, and as authority by people who do. I think the truth is actually somewhere in the middle because the laws of physics actually require a phenomenal concentration of arrogance to stabilize the phenomenal concentration of authority that comes with the Presidency.

What's he got to be smug about anyway?

On the subject of healthcare reform, I think he did a good job of summarizing the reason we should at least talk about it. He said the cost of doing nothing is more than enough reason to do something (cuz the current system is on track to bankrupt the federal government); since we should do something, we should do it right. Doing it right means it doesn't add to the deficit, it protects the middle class and it satisfies healthcare experts. He also said there is so much waste in the current system that we can provide healthcare to everyone; if we can get people insurance that pays for preventative care they won't end up in the emergency room making the rest of us pay for their amputated foot instead of for cheaper counseling on diabetes prevention.

An apple a day keeps our economy afloat for another fiscal year.

The healthcare system is incredibly complicated. That's something that seems to be forgotten when discussing healthcare reform. Additionally, it is a service that cannot be suspended while being overhauled. The average person doesn't even have the language skills necessary to frame the issue, let alone discuss anything approaching a solution. By way of an example, out of the dozens of times pundits mentioned the "cost" of the healthcare reform plan, only a couple times did anyone bother to mention that it was the projected cumulative cost over 10 years, expressed in current dollars.

Even trying to talk about how much it might cost requires several qualifications and each qualification can be further qualified. Thinking about it is tough, let alone expressing it in a sentence. So, instead of admitting how complicated it is, we just gloss over the parts (99.99%) we don't understand and assume there is nothing significant hiding in the fog. It's like when people assumed the ocean floor was flat until they actually got a look at it.

Pictured: Advanced sentence structure.

Anywho, the commentary which followed was even more fun.

CNN

• he didn't add anything new
• apparently Henry Louis Gates Jr.'s arrest is way more important than national healthcare

I suppose we should forgive CNN. Their Black In America 2: The Revenge of Black In America program was airing next and they really wanted to plug it. Apparently the best way to keep the attention of people who tuned in for a 45 minute lecture on healthcare reform is to claim it was a waste of time and that we should be paying attention to some dude who got arrested and then wasn't charged with anything. CNN is classy that way.

FOX

• he's a great liar
• nothing is worth doing unless a list of bullet points can fully explain it

Luckily, FOX was busy furiously ignoring the discussion of what happened to that dude who got arrested (oh, was he BLACK, we totally didn't notice) so they had plenty of time to talk about the news conference. Of course, by "talk about" I mean link everything to Republican talking points and, when that was too hard, tell the audience they should be too confused to remember to blink their eyes or wipe the drool off their bib.

O'Reilly

• I don't understand what his plan is (despite the fact that he opened the press conference by saying the plan is still being debated)
• I don't want the government aggregating rates of medical conditions (despite the fact there is no reason names need to be attached to conditions)

Maybe it's me...but O'Reilly always claims to adore Obama...while always coming up with a reason to hate everything Obama does. In this case he was very clear on two points: that he couldn't understand what Obama was saying and that he went to college so he totally should have been able to. Then he brought in some dude to talk about how healthcare reform is actually really simple, and all the possible changes (all 2 of them) must inevitably lead to a zombie apocalypse.

He'll be standing between you and your healthcare.

AC360

• Tough to make a hard sell for a proposal that's still evolving
• Republicans don't have an alternative, just objections

I think it's the hair. Anderson Cooper, like Superman, realies on his super-powered hair to save mankind once a week. Just imagine the desperate straits we'd be in if his hair was more like this: