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Sunday, September 13, 2009

Wake-Up Call or Snooze Button?

Perhaps the most maddening aspect of watching government at work is recognizing the enormous disparity between the number of things obviously screwed up in the country and the number of those things actually addressed by anything the government does, even when vast amounts of time, energy and money are spent supposedly focused on them. The week of September 6, 2009 is a case study of the phenomenon in the realm of healthcare. Unfortunately, the healthcare debate is not the only consequential example of the problem. It's not even the most important example.


All in One or One at a Time?

Virtually all political coverage in the week of September 6, 2009 was devoted to whether President Obama would formally and publicly support a "public option" in any healthcare legislation then, when his September 9 address to Congress obliquely referenced a public option, more time was spent analyzing if he really meant it and what exactly he meant. Voters and politicians with centrist views watched the fixation from the same vantage point: why, with so many things wrong with healthcare that most agree upon, does Congress insist on giant omnibus bills too large for anyone to understand that include deal-breakers for extremists on the far left or far right? Why can't the Federal government break the problem down into manageable pieces and vote on issues individually?

The reality of our current political dilemma is that NEITHER an all-in-one approach aimed at producing compromise in the interest of progress or a one-at-a-time approach to the legislation aimed at electoral accountability has much of a chance of achieving reforms that truly improve the situation. Why?

The all-in-one approach that uses a single massive piece of legislation to try to fix as much as possible poses the deal-breaking dilemma for extremists. The bigger the bill, the greater the chance it will include SOMETHING that offends SOMEONE on "principle" and will give them cover for rejecting the entire bill. That's really not the most dangerous outcome, though. The real danger of an all-in-one bill is that NO ONE VOTING FOR IT WILL READ IT in its entirety and certainly NO ONE WILL BE CAPABLE OF UNDERSTANDING all the special interest language inserted into the bill and understand the origins of those terms to understand whether they should remain or be axed.

What that really means is that the all-in-one approach poses a substantial risk of containing one or two or dozens of clauses which replace some fatal flaw of the current system with new fatal flaws that could prove equally inefficient or corrupt. One could argue the all-in-one approach DOES help fight special interests by forcing them to attack on multiple fronts at once which may dilute their message and focus and lessen the chance of blocking the debate with demagoguery. However, past history with giant omnibus legislation seems to confirm the risk of really dumb / bad language that defeats any value in a bill remaining in a large bill outweighs the benefit of that bill passing.

The one-at-a-time approach would seem to provide a few benefits but again, recent history proves otherwise. In theory, use of small bills to address issues should increase the probability that members of Congress actually READ the entire bill and UNDERSTAND its mechanics, claimed benefits and claimed costs precisely. In theory, use of small bills to address issues should also then provide voters a better ability to understand exactly what their elected official voted for or against to hold them accountable at the polls with "no excuses".

In reality, the one-at-a-time approach is virtually NEVER used for anything in Congress for exactly this reason. It provides no "cover" for officials to say they only voted for a study to determine why college kids like beer because it was in a bill that funded up-armored humvees for our troops in Iraq. This allows special interests to focus on one issue at a time and pick off opponents via any means necessary. It also eliminates the ability to use counterbalancing pork projects to forge coalitions large enough to pass bills. Any junior high school student of American history recognizes the process -- logrolling. In essence, that type of waste represents the tax imposed by an inefficient, corrupt political process because the only way to get anything through the gauntlet of corrupt politicians and lobbyists is to grease the skids with pork projects.


Political Paralysis Doesn't Stop Change

On any issue, there are always some who aren't comfortable with current proposed solutions and seem to almost take comfort in what appears to be our political paralysis. Their operating philosophy seems to be "I don't like the current ideas, let's just do nothing, keep the status quo and wait for a better idea." Unfortunately, an unchanging status quo only exists in our government. The real world continues to change in ways which are shifting investment capital out of America, shifting jobs out of America, concentrating more power with a smaller number of international corporations and widening the disparity in income and wealth throughout the world.

Normally in a republic, the voters should step in and use the ballot box to demand change and "throw the bastards out." That assumes the voters are paying attention and understand the mechanics of the issues well enough to discern fact from fiction. In the case of America, that also assumes our primary political parties actually present distinct choices and solutions. If the parties are failing to provide meaningful alternatives, use of the ballot box to make a change presumes that it is possible for a new party to be formed and gain enough power to make a difference. In reality, procedural rules at the federal and state government levels virtually assure any vote for a non-traditional party is wasted due to seniority rules for committee membership, leadership positions and election funding.


Wakeup Calls and the Snooze Button

The sad reality is that our political process is being strangled by corruption and special interests and has brought the country to the point where the only force capable of producing material change is massive failure and collapse. How massive? Just consider these examples.

The collapse of the Internet bubble in April 2000 didn't lead to any material change in obviously corrupt practices for IPO stock offerings and bogus mark to mark accounting that fed much of the bubble. It took the near simultaneous collapses of both WorldCom and Enron nearly 18 months later for Congress to make any attempt to improve regulations on accounting fraud and even those changes were toothless due to a lack of funding for enforcement.

The terrorist attacks of September 11, 2001 didn't produce any effort to re-orient America's energy policies to lessen our dependence on oil and reduce the volume of American dollars flowing into the coffers of states promoting militant Islamic terrorism. Indeed, the aftermath of the attacks led us to attack one nation that NEVER HAD nuclear weapons while starving a war in another country for resources that allowed that war to destabilize another country that DOES have nuclear weapons and has repeatedly engaged in proliferation of the weapons and the technology to make them to numerous other countries.

One year ago on September 15, 2008, the bankruptcy of Lehman Brothers triggered a month of near-constant financial failures which nearly triggered the collapse of our entire financial system and led to TRILLIONS of dollars being given away with zero accountability for the recipients. Yet twelve months after that wakeup call that made the market crashes of October 19, 1987 and October 29, 1929 look relatively benign in comparison , NOT A SINGLE CHANGE has been made to the regulation of the institutions that brought our entire economy to the brink. Indeed, we instead are seeing stories about executives of banks receiving TARP money using foreclosed properties of their institutions as personal vacation resorts.

In other words, NONE of these events -- arguably among the biggest "black swan" events to impact the United States in its entire 233 year history and all within the last decade -- have altered the behavior of our government or the behavior of We The People in the slightest.

Stop and think for a moment how shocking those events were to your retirement savings, your livelihood and your loved ones. If none of THOSE events could wake up Americans and force a change, how shocking do you think the event that CAN force a change will be? Believe it or not, healthcare is NOT an existential problem for the United States. Failure to address it will not lead to the collapse of the country, just a sudden, painful collapse of a few related industries and a shifting of spending between employment sectors within the country. Healthcare is a mere warm-up issue to practice our problem solving skills in preparation for vastly more important issues --- energy and finance -- which ARE existential to the future of America as we know it. Both have the ability to cripple the core of our economy and both are currently acting to cement Americans in a role as debtors to the world rather than its leaders.

Wake up, America. The snooze button won't work forever.

Wednesday, September 09, 2009

The Speech We Needed

President Obama's speech of September 9, 2009 had three crucial goals:

1) replace the current sense of paralysis for one of momentum and progress
2) outline a core set of principles that justify the structure of the proposals he's promoting
3) recast the core of the debate from a partisan political battle to a moral reflection of our collective American character -- an appeal to our "better angels"

At this point, any debate about whether the speech achieved those goals may be moot (or "mute" if yous ignert).

The more appropriate question would be -- What was the speech we needed?

Answering that question requires an understanding of the portion of the voting public that's still capable of moving the debate. Based upon most news stories over the past month of "town hall meetings", that audience is actually the large percentage of workers who actually have insurance coverage right now. To date, this group hasn't become terribly concerned or involved with the debate because even though they may not be thrilled with their employer-provided coverage, they have concluded

1) unemployment is high but I still have a job
2) my job provides coverage
3) I may not like the terms of my coverage but I've covered for the big stuff

In short, I got mine, I don't understand all this stuff, so just leave it alone.

Obama's speech ended with a fabulous rhetorical flourish related to goal #3 -- We did not come to fear the future. We came here to shape it. None of that is going to click with the "I got mine" crowd.

What would click?

Here's an abbreviated speech that would have made the appropriate point to the appropriate subset of Americans that could really drive their elected officials to ensure substantive change is made to both health care and health insurance.

--------------------------------------------
My fellow Americans, on the issue of healthcare, we Americans are divided into several distinct camps based on a combination of long-held ideological views and short-term indifference. Frankly, for those of you out on the fringes of the left or right of this issue, nothing I say here will convince you of the merit of any change in your views. We already know how many don't have insurance. We already know the costs of emergency care for those without insurance is being subsidized by those of us with coverage or by taxpayers. We already know insurance companies want to be free to cherry pick low-risk customers yet at the same time preventing lower-cost alternatives from being provided to those excluded from coverage.

For those who have been comfortably indifferent to this issue, it is you who need to listen to what I'm going to state here. I'm talking about you out there with jobs, with families, with employer-paid healthcare insurance who are still ambivalent about the dangers posed by our current insurance and care delivery systems. I'm talking about those of you out there comfortably retired with a pension and retiree health care coverage and a 401k.

Wake up.

You have a job now, but we have fifteen percent real unemployment. Your wages have been flat but you haven't aggressively sought higher paying jobs because at least you have healthcare coverage. Even if you have a job you may not like or sub-par pay, you worry about changing employers because you worry about taking a chance with a new employer who might lay you off with no way to come back to your prior job and resume coverage. Even if you don't worry about the employer change, you worry about whether the new employer's insurance will exclude coverage for a pre-existing condition for you or a family member. The feeling of healthcare coverage limbo between jobs isn't the real issue though.

The real issue you need to understand is the very real chance you don't actually have the coverage you think you do. You've been tolerating a possibly crappy job, possibly crappy pay, a possibly crappy corporate employer to hang on to dear life for insurance coverage that when you REALLY need it may turn out to be a phantom -- an very expensive illusion. The minute you file a claim for a serious (expensive) condition, you encounter a giant corporation bent on finding rules allowing them to exclude payment or allowing them to drop you entirely. After you've paid thousands in premiums for years. After being diagnosed with a condition that will now likely allow any other insurance company to exclude you leaving you completely alone.

The real issue you need to understand is that any healthcare coverage you may enjoy as a retiree of any large company faces grave dangers in the current financial climate. The financial contraction is not over, tighter credit markets will continue to squeeze weak financial institutions including banks and insurance companies and investment firms, further squeezing company pension plans, 401k balances, and reserves for employee / retiree healthcare coverage. If your former employer goes bankrupt, obligations for retiree healthcare are the first to be jettisoned in any bankruptcy.

The current system of healthcare insurance and providers is acting as a growing drag on EVERY sector of the American economy and has reached critical mass in its ability to kill jobs, bankrupt firms and bankrupt families. The only way to break the downward spiral, stabilize the economy and begin re-orienting the delivery of care is to

1) force insurance companies to compete without exclusions or retroactive denial of coverage
2) provide alternate sources of coverage to break the death grip of employers on insurance pricing
3) combine meaningful tort reform with objective, public reporting on care quality to eliminate defensive medicine

That's what the American people deserve, that's what I aim to deliver and that's what you should demand from your Representatives and Senators in this chamber.

--------------------------------------------


THAT'S the speech I would have preferred hearing to kick-start reform.