Health Care Reform: a Postmortem Requiem

Health Care Reform: a Postmortem Requiem

Last night health care reform died.   What went wrong?   A plethora of explanations from all the usual suspects to follow.   You will hear some rumblings of dissent — press on.

The simple answer:  everything was wrong.   This never was about health care reform.  This was always an attempt at health insurance reform.  And in that regard it was a miserable failure.  The bill, as passed by the Senate, was a cruel proposition.  The ultimate lay away plan: pay me now and you might be able to enjoy your coerced purchase in four years.  Do you know how much can change in four years?  Everything.

It involved all the wrong players — Tom Daschle and Max Baucus.   You never involved any physicians, most notably Howard Dean.  This was a policy wonks party gone awry.  2000 pages plus.  It could have been so much shorter.

You never framed the debate.  You never defined the problem.  If you cannot define the problem you have no hope of finding an acceptable solution.    That is why all the DH administration spinmeisters could never convince us of the positive benefits.

Almost immediately, and for one protracted year, this debate was a diversion from the most pressing issue facing Americans today — an anemic economy with unemployment numbers never seen in our lifetime.   The real unemployment rate in California alone is estimated at 18%.  This is not the stuff of a vibrant economy.

I saw Up in the Air this past weekend.  I will admit George Clooney is one of my favorite actors.  Along with Matt Damon and Clint Eastwood —  effortless, articulate, compelling performances — always.   What was so poignant about this movie was the repeated face-to-face encounters with a diversity of people, of all ages, backgrounds and skills — about to lose their job.  The pain, the pathos was immediate and palpable.

This is the major issue of the day.   This is how and why a president’s popularity plummets — always.

Last night a lifeless pretender to the Kennedy throne was outfoxed by a beefcake from the right.   Just as Gray Davis was outfoxed by Arnold Schwarzenegger, the Lion of the Left is superseded by a new media pin-up.  Mr. GMC pickup man.  Mr. Everyman.   American Idol.  He is a Rorschach inkblot of simmering angst.   Public officials have taken their eye off the ball.

Bill Moyers interviewed Kevin Drum and David Korn who sadly concluded that we have been hypnotized into thinking that big business is always preferred to big government:

KEVIN DRUM: … You know, in poll after poll for decades now, if you asked people who are you more scared of in terms of America’s future, is it big government or big corporations? Big government always wins by a landslide.

Tony Blair, even more succinctly encapsulated the entire political paradox four years ago:

Fierce struggles about nationalisation or privatisation, about the precise level at which public spending started to crowd out private investment, dominated the era of post-war politics.  Conservatives were for ‘business’, often ‘Big Business’, progressives for trade unions and the public sector.

And above all a state that sees its role as empowering the individual, not trying to make their choices for them, can only work on the basis of a different relationship between citizen and state. Government can’t be the only one with the responsibility if it’s not the only one with the power. The responsibility must be shared and the individual helped but with an obligation also to help themselves.

And his vision for the National Health Service (NHS) of Great Britain:

In 10 years time, and if possible long before, I want the health debate in Britain not to be confined to the excellent NHS that treats people when they are sick; but to the broader national health service that is about prevention as much as cure, about personal responsibility as much as collective responsibility, about the quality of living as much as life expectancy. It is an ambitious goal. But one totally in tune with the times. It means changes in Government, business and people, but that is the way the modern state should work.

The Guardian Wednesday July 26 2006

Great leaders learn more from failures than success.  Regroup.  Refocus. You’ve met your Bay of Pigs.  The best defense is a good offense.  Time for boldness, not shrinking and cowering.  Now go back and fix what really matters most.  “It’s the economy stupid.”

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