Taking a Stand for the American Dream

Since starting the American Dream Project I have been an active proponent of the strong values of our founders establishing a society that promoted the greatest happiness for its citizens.  This is happiness based on integrating the values of self-reliance and a shared civic concern for the common good.  As a nation we seem scared.  Our jobs have disappeared, our education and health care systems are broken and we owe nearly a trillion dollars to China.  Meanwhile we swim in a torrent of special interests that use the language “personal independence,” “maximum material success” and “sacredness of property rights” to marginalize the values of social responsibility, sustainable consumption and the sacredness of human rights.  It is frustrating that when we attempt to solve our problems using wisdom, creativity and higher values the debate degrades to a war of special interests trying to rig the future to their benefit.  The only counterbalance to their self-aggrandizement is citizen resolve to reach for new solutions.  Solutions that honor all our legitimate values but ensure fairness to all.

This is difficult.

That’s because we believe that what we know is reality.  But reality is a tricky beast.  The problem is that reality has at least two dimensions.  The facts of a situation represent the content of reality while the meaning of those facts is the context.    Our sense of meaning is driven by our values.  And for our values to be useful in making decisions they must be held in hierarchy.  Simply put, some values are more important than other values.  Values tell us what to do with facts.  That’s why it’s so important not to let others define our values or confuse us as to what’s most important.  Because, if we let them, they will create a closed bubble for us.  And in the bubble of their emotional logic their conclusions will make total sense.  Soon we’ll be interpreting all facts through the false reasoning of the bubble like clones in a frightened world.  This is not just a theory.  People who call President Obama a Nazi or a socialist and people who label conservatives as hillbillies and hate-mongers make the same error.  They are trying to recruit followers through fear.  This is very dangerous.  It’s what happened when Hitler hypnotized Germany.

When the courageous Christian pastor, Dietrich Bonhoeffer was struggling to find ways to rid his beloved Germany of Hitler, he wrote a series of essays that point out the folly of being seduced by those who appeal to our fear and pride, and pointed out that followers become spellbound by slogans and repeated assertions that gradually become “facts” to morally passive followers.  As simplistic slogans are spread by an over-active media, a moral flu has the power to inflict a whole society. When our prejudices are enthroned in a twisted emotional logic that our self-interest is the premier virtue, facts and evidence that contradict our opinions are simply disbelieved and dismissed.  As a successful business owner recently said to me, “I know what I believe is true, so why should I listen to anything that would make me question my convictions?”  Why, indeed.

What Bonhoeffer, who was executed by Nazis three weeks before Hitler’s suicide in 1945, pleads for is for us to “take a stand.”  His call is to stand for love.  He called on Christians to save Jews because the great work of moral humans is to bring relief to all who suffer. He challenges us to consider “the outcasts, the suspects, the powerless, the oppressed…with new eyes of generosity, humanity, justice and mercy”.

In my view the greatest act of humanity is to relieve today’s suffering and build self-reliance so that all people can lift themselves to a decent, hope-filled life.  My work with the Grameen Foundation, who empower the poorest of the world’s poor to lift themselves by providing access to microloans so they can become self-sustaining entrepreneurs, convinces me that the vast majority of humanity has the will, talent and ingenuity to live a responsible life.  They just need the tools to get started.

To return to the beginning, I am saddened that demagogues in our nation can rally millions with fear-based messages with the primal message, “Every man for himself.”  I also worry that public spending that weakens our self-reliance and creates institutional dependencies is old failure path. The people I most respect are those who hold strong beliefs, recognize that evil is real, exercise timeless values and continue to have an open mind.  Above all, they refuse to be driven by fear, pride or intolerance.

For me there is a higher center that calls for civic engagement in the common good, the restraint of greed, and the promotion of self-reliance.  It is time to take a stand.   A time to stand for our highest values.  This is not time for fear and divisiveness.  It’s time for creative idealism and a fiercely open mind.  These issues are great questions of our day.  (For a view on my suggestion on healthcare that attempts to blend personal responsibility with citizen lead social responsibility, see my other posts: Outraged at the Politics of Healthcare and Will Marre’s Radical Solution to Health Care.)

So what do you think?  Am I missing the point?  What do you believe are the answers to our challenges?

Outraged at the Politics of Healthcare

I’ve really tried not to write this. I’ve said my peace on a national health care make over (see Will Marre’s Radical Solution to Health Care), but now my hair is on fire. Those framing the debate are focused on all the wrong things. We cannot repair a completely broken model. We must re-think and thoroughly re-invent health care. Arguing about projected costs made by assumptions that can’t be validated is pretending to know the unknowable. Trying to close a $1 trillion gap is an exercise in science fiction. It is also strange that Republicans are so concerned about costs when they gleefully agreed to pay drug companies a trillion dollars in a deal George Bush made on Medicare drug benefits. They weren’t concerned about the trillion-dollar cost of a non-strategic war, but now when we want to end our Neanderthal ways of health care, they are wringing their hands. Right.

The financial interests that currently thrive on our broken system are reportedly throwing $10 million a week at keeping their flood of money flowing. The current system is constantly escalating costs and shrinking benefits for those that can afford insurance. Most people have no real idea what costs are actually covered by their policies because they are so complex. And the whopping bottom line remains—we have the most expensive per capita health care system in the world with the worst results in the developed world. Yet this is the system that is being defended by the brainless mouthpieces on right-wing radio and television. This is not the best we can do.

How bad is our system? Well, the American Medical Association estimates nearly 1000 people a day die from mistakes made in our state-of-the-art hospitals. Die. That’s not a problem. That’s a tragedy. The FDA approves drugs for wide use and promotion on television that kill people. Vioxx anyone? Last year my mother-in-law was hospitalized for four days. She never saw the same doctor twice. Instead a team of hospital-based doctors strolled through her room cluelessly looking through paper charts muttering questions about the previous doctors’ prescriptions. Their big achievement was completely disrupting her blood sugar levels that she had spent years controlling. She was released but never was able to get them under control before she died nine months later. Our current “system” is polluted with toxic self-interest at every turn. And the competition of competing self-interests has not produced high-quality low cost care, but it’s opposite—low quality, high cost industry. And the answer is not some medical version of the post office, an expanded Medicare system or a mish-mash of compromises of special interests. To re-invent the system we must revolutionize it.

First we begin with the premise brilliantly articulated by the philosophers who inspired the American ideal of life, liberty and the pursuit of happiness. The father of moral capitalism, Adam Smith, argued that the purpose of any economic system must be to maximize human benefit, to maximize the quality of life for the most individuals. He opposed slavery, child labor and all forms of economic exploitation. Jeremy Betham proposed that the best society was the one that created the most opportunities for happiness. This means that as governments form to promote public policy they ought to be focused on reducing avoidable suffering. That’s a big idea. Reducing avoidable suffering. And history is clear the most efficient way to do that is to empower individuals to be self-reliant by eliminating or controlling special interests, powerful cartels and a monied aristocracy while providing a public and private infrastructure of education, transportation, electricity, technology, access to capital, and yes, health care. This doesn’t mean the government has to provide these services; rather, our government needs to provide a system of enforced laws that prevent the powerful from manipulating and exploiting the middle class and the poor and provide infrastructure when the common good is served.

An American version of universal health care should:

1. Make each of us responsible for our own health care up to 3% of our household income each year. This responsibility will reward healthy lifestyles and promote service providers like Minute Clinics and keep us personally responsible.
2. Make all citizens part of the 300 million member group that dilutes individual catastrophic health care risks across our entire society. We need to be committed to our common good.
3. Tax harmful habits, food and beverages so that people who consume them contribute more to health care.
4. Create a non-governmental non-profit citizen co-op to manage health benefits whose employees are highly bonused to create six-sigma quality service.
5. Radically increase the number of nurse practitioners and physician’s assistants to lower the cost of routine care. Increase incentives for preventive care and eliminate incentives for redundant, wasteful testing and lab work.
6. Bring the cost of all prescription medicine to be no more than the average paid across the 20 most developed nations.
7. Eliminate the strange connection between employment and health insurance. It’s both bad for business and traps people into jobs they don’t want. It makes us less competitive internationally.
8. Allow and encourage a competing private insurance, private hospital, private doctor system to spring up so that no one can claim health care is rationed. That is, anyone who chooses to afford extra tests, extreme measures and other services our society cannot afford should be able to get it on their own terms.

Obviously these are broad ideas, but they serve as a framework for common sense thinking about American health care. Meanwhile, what are we likely to get? Most probably a hodgepodge of deals and compromises that enable the medical aristocrats to continue to make billions of system inefficiencies while ignoring the real opportunities for healthy change.

Our mutual quality of life depends on more of us understanding that the most important things in life are more than the sum total of commerce. Health care and commerce are simply not ideal partners. When we try to make it so, corruption is the sure result. This is what gives capitalism a bad name. We need bolder leadership. Moral vision and clear ideals. Frankly, regarding health care we need to go back to the beginning and start all over again.

Will Marre’s Radical Solution to Health Care

How does paying $25,000 a year for health care sound?  According to the Consumers Union that’s what the average family will be paying in 15 years if we don’t do something now (See Myths on Health Care in USA Today).

Some issues that impact our lives and our children’s future are so big that it takes an extended article to say what needs to be said.  Health care is one of these issues.  I worked in the health industry for eight years consulting with two multibillion-dollar hospital groups with sterling reputations.  I worked with many great people who wanted to do the right thing in the right way.  But our health care system is so goofed up and so internally competitive with doctors, hospitals, drug companies and insurance companies all hammering each other for a piece of the hurricane of money blowing through health care.  I use the term ‘hurricane’ because the money we spend is a storm of waste.

According to the Consumers Union, $500 billion/year is wasted in ways that frequently hurts our health instead of helps us.

I present my idea as an idea-starter rather than a complete plan. One thing for sure, tweaking the status quo will not work.  We need something far more radical….

Yes, according to our Congressional Budget Office, the biggest threat to American’s quality of life is…you guessed it…our bizarre health care system.  We all know by now that the U.S. has the most expensive, least effective health care system among all developed nations.  In the richest country in the world, we all too frequently see canisters in grocery stores asking for hand-outs to pay for cancer treatments for a child whose working parents’ insurance doesn’t cover treatments.

With 47 million uninsured and at least 100 million more of us increasingly under-insured, no fair-minded person can claim our current system works.  The cost of inadequate coverage has reached the ridiculous.

My own family’s policy, which is a high-deductible monstrosity full of coverage limitations, has increased in cost by 40 percent in the past 2 years.  And no we haven’t had any major illness or accidents.

Although there are many players in health care we could blame for contributing to our problems, the private health insurance industry is the one that is most problematic. That’s because our large health insurers are worried that their core business model is ill suited to help today’s consumers.

They have already spent $22 million trying to scare the public into thinking that socialized medicine is coming with its inevitable mediocre care.

Meanwhile Congress is coming up with some super-expensive half-baked compromise that is likely to make things more complicated, more expensive and subject to future corruption in ways currently unimaginable.  Either way, the middle class is likely to wither due to massive taxes or massive direct costs that may even be more than taxes.

What’s needed is something far more radical, daring innovation that revolutionizes health insurance as it reduces cost and complexity.

1. First we must bury the idea that health insurance is an “industry” or a business. The profit motive works great for giving incentive to commercial genius to create iphones but it gives incentive to all the wrong behavior when we’re trying to create an all citizen access to health care.This isn’t hard to understand.  Profit arises from the difference between premium income and overhead costs and health claims.  Thus insurers are rewarded for only insuring the healthiest people and paying as few claims as possible.  So that’s exactly what we get.  Today our health is brutally rationed by the insurance industry.  Increasingly numbers of people simply can’t get health insurance ironically because they need it.  We also get claims denied and benefits arbitrarily limited after we’re ill by armies of insurance company employees who earn bonuses by keeping payouts limited.  It’s called mis-aligned incentives.  The companies selling insurance profit the most when they deny me the benefits I thought I was buying.  That is unfixable.  No amount of regulation will match the problems that mis-aligned incentives cause.
2. Government cannot effectively administrate an expanded Medicare-like bureaucracy to cover all American’s in an effective way. Government bureaucracies grow proportionately less efficient and effective with size.  Costs will soar and service decline.  Government bureaucracies are exceptionally poor at promoting high operating performance because individual workers are not systematically incented to excel. We all know this.  I am not suggesting all government workers are lazy, rather that all bureaucracies, public or private, are poor at rewarding merit.
3. The solution is something new.  Something called Civic Enterprise. A Civic Enterprise uses the efficient disciplines of business to achieve social goals at the highest possible quality at the lowest cost.  This is achieved through totally aligning incentives.  Here’s how.A Civic Enterprise for American health care would function as an all citizen non-profit co-op we all own.  It would operate the way large corporations self-insure.  Every citizen would be eligible for a universal level of humane benefits.  Every person would have a deductible equal to 3 percent of their income so they would seek the lowest cost provider for minor sicknesses and injuries.  This would motivate low-cost, high volume free market providers like Minute Clinics to thrive.  (This 3 percent is not a tax.  It wouldn’t be a cost to people who didn’t get sick or injured.)The co-ops insurance benefits would be administered by regional centers whose employees would be incented to get the most people enrolled and well served with the specific treatments that conform to best practice guidelines.  Six sigma measures for quality and efficiency would be embedded into the system so co-op employees could earn substantial bonuses for providing excellent and timely service.  Good performers would be rewarded and poor performers weeded out. The main business driver would be to provide the best coverage to the most people to increase citizen health.
4. All citizens would have the opportunity to take online or in-person health education classes. Doing so would result in lower deductibles.
5. Funding would come from dismantling our Medicare bureaucracy and new health taxes on all products that contribute to poor health. These include manufactured food and beverages whose primary ingredients make us fatter, clog our arteries or trick us into thinking we’re hungry.  Also taxing polluters who contribute to lung disease and cancer also puts the tax on the modern sources of environmentally caused illness.

Yes of course there will be screams from the businesses that profit and prosper from promoting risky behavior, make fake food or foul our air and water.  These taxes are not anti-business.  They simply reflect the real economic costs of producing certain products.  Government’s legitimate responsibility is to tax private companies for the social costs caused by their operations.

In a market economy everyone needs to take responsibility for their impact on the health of the total marketplace and that means the impact their product or their production process has on society’s health.  It’s only fair.  So go ahead and make your cigarettes, Twinkies and coal plants, but you and your consumers must pay for the health consequences you are creating.  That’s as pure a market-based economy as I can imagine.

The bottom line:

Let’s all get on the same page.  If we align our economy and our incentives toward promoting health, self-reliance and taking responsibility for all our actions, we can solve our health care crisis.  We need to focus on performance rather than profit.  If we let business-as-usual cut off real innovation that we need, we’re headed into a Grand Canyon of quick sand.

What’s the best thing we can do? Get in our Senator and Congressman’s face and demand real solutions that improve effective care, universal access and hold down costs. ( Write Your Representative or Contact Your Senator.) Engage with the White House and President Obama in today’s Town Hall on Health Care Reform.

Postscript:
Some Things that Make No Sense

1. That we get health insurance through our employment.  It’s a burden to our economy and few of us work for companies that provide insurance.  Get employers out of the health insurance system.  We need to get our insurance directly and everyone should be covered.
2. Don’t pass a law requiring we individually buy health insurance from a private, profit-motivated insurance company.  None of them put my interest first.  Comparing this to mandatory car insurance is absurd.  I choose not to have a car.  I can’t choose not to have a body.  Enroll me in an effective non-profit Citizen Enterprise plan.

So what do you think?  The more constructive ideas that bubble up, the better our solutions will be.  So let’s hear your ideas.

You can also read some of your ideas/comments on my previous post, “Who Will Pay for Healthcare.”  Thank you for your insightful thoughts.

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