Liberty and Health Care—The American Dream

Is the Right, right? That’s the question we all need to consider. Today we hear the urgent hand-wringing cry that true health care reform that would protect all Americans and lower the cost burden of health insurance on our businesses is both unaffordable and un-American. Well is it? Consider the ideal of the American Dream. The fundamental promise that where we start in life doesn’t determine where we finish. Let’s look at the core ideals of our founding and then whether our national priorities need to re-enthrone what we are all about. Let’s begin with liberty.

Liberty is more than an absence of laws. That is simply anarchy. If liberty contained no other values than the freedom to be left alone we would create a “Lord of the Flies” society where those with power simply impose their will on those who have fewer resources. Our American concept of liberty is found in equal protection of the law. The ideal is that all of us have an equal chance at a decent life. No, there are no guarantees of personal wealth and effortless bliss. We have a staunch revulsion toward income redistribution and protecting people from the consequences of their own poor choices. But we also have passion for fairness; we hate bullies and raw deals. We are also audacious and outrageously optimistic. In fact, we are so bold that our founders created a nation based on the idea that we should strive for a society that created the greatest opportunity for personal happiness. They well understood no one could hand us happiness on a silver platter or even a check for a zillion dollars. In fact, it is actually the true pursuit of happiness that makes us wise enough to eventually see that the effort-filled journey comprised of learning, doing and loving is what makes us happy. Happiness is found in its genuine pursuit. Amazing.

But the founders and wise successors like Lincoln also understood that our quest to build a society with maximal opportunity required us to reduce the causes of avoidable suffering. Avoidable suffering is usually caused when powerful interests oppress the less powerful because it makes them richer. The practical wisdom of our founders understood that the concentration of wealth and power is a force of gravity that if left unchecked concentrates political influence, which destroys equal protection of the law and the basic underpinning of society to create a level playing field for all. This requires a genius-like balance. If government gets too big then its vary corruption by private power amplifies their power. But if government is too weak then the hidden aristocracy of the financially powerful will inevitably exploit the unrepresented common citizen.

So a proper role of government for the best society is to continually renew efforts to create fairness and legal equality for all citizens. This is not child’s play. The forces we deal with are titanic and those who use the propaganda of bumper stickers to convince us voters to support the very policies that hurt our own chances for happiness are clever and loud.

This is what we know from worldwide research (World Values Survey). A level playing field for citizens to pursue happiness is created when we have universal access to 1) quality education, 2) reliable health care, 3) clean water, air and land, 4) business capital, 5) infrastructure, especially transportation, telephones and the internet, and 6) equal protection under the law. In any society in the world if those six things are available citizens will thrive.

Today, we are hurting in a big way from providing three of six. Our education system is broken as each year we dump at least a million 18-year-olds into the streets degree-less, semi-literate and bound usually for jail. Our health care system has become an interlocking cartel that prospers from the status quo. Our banking system has little capital for job-building small business but plenty of dough for bonuses.

The core reason is actually the same. The concentration of power in too few self-interested people. In education we are crippled by accountability-resistant unions and archaic laws that starve funding from our poorest schools. In health care the anti-trust exemptions and corporate sponsorships of elections have vaporized honest competition and made real cost control impossible. And in banking the financial center has moved from Wall Street to Washington.

So what might we do? Government has proven most effective NOT BY DIRECTLY PROVIDING SERVICES but by passing new laws and effective regulations and enforcing them. These regulations must also include robust anti-trust provisions that prevent too-big-too-fail and too-rich-to-ignore special interests from compromising the regulation. As independent “I can take care of myself” Americans we have a revulsion against regulation. But research confirms that the right kind of regulation is exactly what permits equality of opportunity and high living standards. For instance, regulations that create an equal standard for all businesses generate innovation and breakthroughs. Cars would not have seatbelts or airbags, our rivers and air would be sewers, our drugs scary, our food unlabeled, our credit cards ruinous and our workplaces toxic if we citizens, through our government, hadn’t insisted on regulating the self-interests of those whose are willing to cause suffering to get richer. Every time we have tried to make America fairer for everyone in a big way, the voices of the powerful have wrapped themselves in the flag and pretended to care about yours and my freedom. Every time these voices told us that freeing slaves was confiscating the wealth of the slaveholders. It’s unconstitutional! They argued that prohibiting child labor would bankrupt us. They said unemployment insurance would make us free loaders and all highways should be toll roads. In the 1960’s they said giving African Americans the freedom to eat and sleep in any restaurant or hotel was a violation of property rights. These are arguments without moral merit. Not only because they strike at the very root of what makes us American, but also because we all deserve an equal chance at life.

Today millions of Americans are uninsured, underinsured or a layoff away from it. We must do many wise things to correct this. Government’s role should be to remove the grip of special interests and to create regulations and incentives to control costs and increase coverage. Doing nothing for all who are suffering is what’s un-American. After all, what kind of country are we?

In health care we need to consider 4 things:

1. Make all citizens part of one giant covered group where we all pool our collective health in one risk pool as this will reduce the overall costs to business and society as well as our individual costs.
2. We need a national citizen co-op to offer an alternative coverage to private insurers whose internal overhead and salaries have swelled 10% in the past year alone and whose profits have increased 250% in the past decade (Union Tribune).
3. Control costs by instituting quality control and six sigma practices like the Cleveland Clinic, Intermountain Health Care and the best of the best do.
4. Teach, promote and reward health and wellness lifestyles everywhere.

Perhaps the thing that makes me saddest about this whole health care debate is that there is no voice for moral priorities. We need to stop our talking points, pouting and fear mongering to use our innovative ingenuity to truly create a future where we can all thrive instead of being told we can’t by those who already have everything they need. That is the oldest lie in politics. I called my Congressman’s office and told them they better do something positive to change the future. Complaining and whining just don’t get it.

The Gifts of Facebook

Facebook is magical! A long lost friend reconnected with me this week. His name is Robert. I hired him when he was 23 and I was 42. I needed some help in launching a new company, and he seemed like a very bright, young, energetic, and ambitious man. Boy was I right! We only worked together for about a year, and then he began his real life adventure. Now, he is 40 and the CEO of a five billion dollar health care company. At 36 he was one of the youngest chief executives of a billion dollar publicly traded company in the world. A reconnection 20 years later was very gratifying. He’s exactly the kind of leader that I would have hoped he would become.

How is he so successful?

How has he become so successful so quickly?

Well, he has a secret. He didn’t tell me what it was, but after spending three hours with him it was obvious. He is a visionary who sees what is missing. He has a knack for understanding all the steps and missing pieces between vision and reality. That may be one of the rarest skills of all…and when he sees he’s not afraid to act. What’s most amazing to me is he’s not full of himself. In most of my experiences people who have had extraordinary success at young ages tend to think they’re so much more special than everyone else. They make themselves obnoxious. Well, not Robert. He’s confident, yet humble. I think most of all, he’s a hungry learner. He’s constantly paying attention to what he doesn’t know, and seeking ways to fill in the blanks.

On a side note…as a health care executive, he agrees that insurance companies are not well suited to provide insurance. That is not a miss print.  What we both believe is that insurance companies are designed to make money, not pay for medical care. Insurance is just a means to an end for most of these companies, and so you get the kind of behavior that everyone talks about. I still believe that a national non-profit citizen co-op is the ultimate answer, with private insurance providing companies for people wealthy enough to want to have a custom program. I guess we will see!

Health Care Dominated by Financial Interests - No Leadership in Politics

Recently, my children and I spoke about our President’s evident failure to lead. One of the first rules of leadership is that leaders need to describe the “what.” If a leader cannot adequately describe the benefits of going to the promised land, no one will follow. Great leaders also allow others to decide “how” or at least to input in, “the how” so that there can be wide agreement that the way we are going to get to the promise land is sustainable. Instead we see our politics as usual…the politics of compromise.

How can compromise work when health care is so dominated by financial interests? Health insurers and drug companies are spending a reported $1.6 million dollars a day. They have hired over 1,000 new lobbyists, most who have been former congressmen or former staff members of congressmen and senators, to work their old colleagues into compromising what should be a moral imperative into an expensive trick. We have a habit of doing this in our country when it’s evident that things need to be done, the forces that make the most money from the status quo push compromise.

We had a real chance to end slavery when our constitution was drafted but we let the economic forces in the south sustain slavery, so our country continued with it for over 100 years. After the Civil War, we could have really installed civil rights laws; making it possible for everyone to vote, but we didn’t. It took another 100 years of civil rights laws to give every citizen in this country the same rights, and still we live with its aftermath. This is not a way to build a society. There are some things that we cannot compromise. In today’s world, we simply cannot be the only developed country in the world that doesn’t provide basic health care to all its citizens. The truth is, it is affordable; it just isn’t affordable in the way that people are presenting it, and that’s on purpose.

When we combine profit and overhead from the top seven biggest health insurance companies in America, it’s $400 billion dollars a year…or $4 trillion that is spent every decade. Only eighty cents of our premium dollars spent with private insurance companies are actually spent on health care. Medicare spends 97% of our tax dollars, but Medicare in its current form isn’t the answer either. It is far to subject to the failings of political bureaucracies. Medicare is loaded with waste and inefficiency.

There are solutions! A national citizen co-op could also work on a very high level of efficiency limiting what is spent to somewhere south of three percent. Also, if every individual agreed to spend up to three percent of their income on health care out of their own pocket we would be much more careful on our purchases of health care, using the Internet to find out what is best, and by following doctor and hospital ratings. This is truly within our grasp, but we are letting it all go because of old style thinking. If people want private health care, they can get it; just like some people send their children to expensive private schools, people could hire private doctors and have private hospitals. There are excellent universities ran by the public. The University of California Berkeley, and UCLA are examples of schools that provide educations that are certainly equal to the Ivy League schools. So the idea that private and public solution can’t exist at the same time is just simply not true.

But, rarely do we hear of this from our President or his leaders. Instead we hear what is absolutely necessary, and what is willing to be given up, and what is likely to be a Frankenstein version of a public and private health care that is full of corruption, just like our defense procurement processes are. Hopefully, my assessment of our new President’s leadership capabilities or intent is premature.  If not, we’re going to be in for a long slog of the same.

FOR MORE ON HEALTH CARE, SEE MY OTHER POSTS:

Outraged at the Politics of Healthcare

Will Marre’s Radical Solution to Health Care

President Obama’s Leadership Lite Act

Watching Obama and his Leadership Lite Act around health care is very interesting. He seems very confident. As an independent voter, I actually favor a citizen co-op, and large personal deductions to drive personal responsibility. In any event, I think any thoughtful person knows that health care needs to be wrestled away from the special interests that control it, and that are currently driving our country to bankruptcy one person at a time.  Obama’s leadership on the issue seems to have an extraordinary light touch. Meanwhile his opponents have become raging parodies of Sarah Palin, if that’s possible. They seem to have been very successful in whipping up post 65 year old Medicare recipients, railing about government-funded medicine. That’s bazaar…a world on steroids. Meanwhile, Obama is the king of cool. We’ll see if it works. The strategy that Muhammad Ali used, allowing his opponents to punch themselves out worked in a boxing ring.  It will be very interesting to see if it works in politics.

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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Big Companies Can Do Good

Big companies can do good, especially when they embed corporate social responsibility into their core strategy. I am working with a company that is an American icon. Their products are in virtually every American home. I spoke with senior executives whose goal was simply to do as much good as they could and make money doing it. They’re in the health care business and they are serious about making money by reducing the demand for their products by making people more healthy. In the session yesterday we learned that 80% of Type 2 Diabetes is preventable, and 70% of all chronic disease is preventable. All it takes is a little life style change: how we eat, how we exercise, and our personal habits. Not doing so costs us a lot not only in direct health care costs, but they estimate over a trillion dollars a year is lost due to productivity due to illnesses caused by our own bad habits. They plan to teach, motivate, and ascent people likes never been done in the world, to live a more healthy life. These are smart people, they have good plans, and their hearts are in the right place. I’m convinced they really can change the world right where we are. All we have to do is speak up!

Who Will Pay for Healthcare?

FREE DOWNLOAD:  The 4th American Revolution by Will Marre

As the debate on health care rages on in Congress it is sobering to watch the gears of politics grind slowly through the constant dump trucks of sand delivered by the powerful economic interests of the health industry.  The incentives of the industry are often contrary to health.  Insurance companies make money by charging small companies and individuals who have no bargaining power exorbitantly higher rates than employees of the government or large companies who do.  Insurers make more by denying claims of the seriously ill and excluding people who are afflicted with a pre-existing condition.  In short, they prosper and please their Wall Street analysts by limiting benefits, which is a cruel way of rationing health care.  That’s the very term the far right uses who oppose universal health care.

The economics of drugs is also a labyrinth of questionable practices.  Many drugs come as the result of taxpayer-supported research at the National Institutes of Health.  Drugs’ retail cost varies greatly based on what country you live in or health plan you have.  Again those who have no bargaining leverage pay the most.  And most strangely the drug companies spend much more on consumer advertising than on research.

On the cause of the illness side of things, we have cigarette makers who don’t want to be regulated by the FDA even though their product kills 400,000 Americans a year and will kill over a billion people worldwide in this century.  That’s 15% of the entire world population currently living.  And the fake food industry continues to design, package and sell high calorie low value foods to people most unable to find affordable fresh food.  Of course these industries massage their collective consciousnesses by telling themselves we only make what people want.  If that logic absolves them from the death and suffering caused by the common use of their products then I guess it’s hard to blame cocaine and meth. dealers who are only meeting the demands of the market.  It all carries an economic logic that relieves everyone of his or her social responsibility until your mother or sister starts suffering from diabetes or your father dies of lung cancer.

So we have Congress and their mighty lobbyists trying to sort out an affordable health care plan.  I am pessimistic because today we need leadership not compromise.  Compromise which ends up with a little of this or a little of that produces a lot of nothing for consumers and new revenue streams for those who see this as an economic exercise.

There are many brilliant solutions to our many health care challenges.  And yes, they would overall cost all of us less money, but we have no voice in this debate because there is nothing to be economically gained.  So the gears grind on.  Who will pay?  We will.  What are your ideas/solutions?

For more on my views of health care, read the 4th American Revolution.

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If I were President…

There is no job in all of the United States as closely scrutinized as that of President of the United States. Even the celebrity scandals with which much of the country seems to be so completely obsessed at times, can not compete with the scrutiny on this one job. Leadership is the glue that binds us together. Whether or not we realize its value, the effects of its absence are unmistakable. Leadership is more than a title, and there are many who have held the title but failed to lead. Since I, like many others, will be closely scrutinizing the actions of the next President, it is only fair that I answer the question.

What would I do if I were President?

Domestic Policy

The establishment of an aggressive national energy policy.

1. An aggressive national energy policy would be the keystone to my administration. Americans believe in and want clean renewable sources of energy that can be produced here in the United States, but the government needs to create an environment that is friendly to innovation and provides incentives to buyers and producers to make this happen. Up to $700 billion dollars a year would be brought back in the U.S. economy (potentially more with the sale of clean energy technology overseas), jobs would be created, the environment would be cleaner, and we would eliminate the threats to national security that are inherent to depending on foreign nations for a vital resource. Perhaps, most importantly of all, however, is that this is really something we could use to energize the country to work towards a common goal. For more information about the need for a vital new energy policy consider Will’s post Oil Dependence and the Energy Crisis.

2. Formation of a service for education program.
   America has earned its economic standing in the world through innovation: electricity, the automobile, the computer, and the Internet to name a few. We also have a need for educated individuals to serve the community as doctors, nurses, and teachers to name a few. Throughout the years, many young men and women have turned to the military as a way to build a future for themselves. Service to country has prepared many of our youth to become responsible citizens and instilled in them a love of country that is necessary in a healthy society. Education, when offered openly to all who will take advantage of the opportunity, has the potential to be the keystone to balanced equality in our nation. Expanding the definition of service beyond the military and creating structured opportunities for community service in exchange for education would be a priority in my administration. For other great ideas about expanding education, see Will’s “Free Education for All.”
   

3. The establishment of a state/locally run national health care program.
   In a country like the United States, it is inexcusable that working men and women are unable to obtain quality medical care for themselves or their families. If a man or woman works to be a productive member of society, surely they have earned the right to real medical care. We are not talking about taking from the rich and giving to the poor; we are talking about giving people what they have justly earned. Such programs have met with tremendous opposition because we have lost faith in the government to spend our money wisely. I am very sympathetic to this argument.  In order to ensure that people have the kind of medical service they deserve without another bloated federal program, I would work to ensure that the program was implemented at the state or local level. The federal government would require a program meeting basic standards and would provide oversight, training, and support. There would obviously be expenses associated with such a program, and extensive research would be conducted to ensure that they would be minimal and fairly divided. It would replace the Medicare program, and the expenses which currently go to that program would help defray the cost. Participants in the service for education program listed in item 2 would also play a key role to keep expenses down.

Foreign Policy

1. Push for massive reform in the United Nations.
   The U.S. can no longer afford to be the world’s police force. Our adoption of this role has placed an unfair economic burden on U.S. citizens and has done unnecessary harm to our relationship with the global community. Although we can not, and should not govern ourselves by foreign opinion, we should try and maintain fair and amicable relations wherever we are able. We need a global body that attempts to resolve disputes between countries, and that when required, can act to enforce the peace between them. These actions need to be a community decision and need to respect the sovereign status of each of its members. I do not believe that the U.N. is currently up to the task, but I believe the answer is to push for reform that puts reasonable bounds on their authority and seeks to remove corruption from that body. A well run United Nations will free us to focus on making a better life at home, while discouraging the types of aggression that led to World War I and World War II.

2. Heavy reduction in non-humanitarian foreign aid.
   According to the National Debt Clock, the current debt of the United States government is $10, 542,780,984,853.05 or approximately $34,563 per person. I have intentionally left every digit in the sum to convey just how enormous that debt is. Foreign Aid spending adds approximately $15 Billion a year to that sum, with the Cato Institute estimating that number at closer to $50 Billion and heavily opposed by the American people. The United States should be a good neighbor, particularly where disaster relief is concerned, but it is irresponsible to spend such a large sum of money on foreign aid while we are so deeply indebted. This is especially true in those situations where the aid is being used to buy influence. I would not eliminate foreign aid, but I would cut it deeply.

3. Heavy reduction in U.S. military presence abroad.
   The purpose of the military is to defend our way of life. It protects our freedoms, and in a larger sense, our prosperity. Its ability to perform these actions is vital to our well being. Economic vitality is also of fundamental importance to our well being and we must be careful to balance these two competing priorities. $644 billion was requested for military spending in 2008, more than the next 10 highest spending countries combined based on a Reuters release and can be seen clearly on this Wikipedia chart based on the 2006 budget. The military plays an important role in protecting our economy, but we must avoid the danger of the military becoming the economy. Economic instability poses a serious threat to our national security. Heavy reduction in U.S. military presence abroad would be a good start at bringing these numbers under control.

Government Reform

1. Tax Reform
   Taxes should be simple, and loop holes found in fine print should not exempt people from paying their fair share. One solution which has been proposed to this dilemma is the implantation of a flat tax. A true flat tax seems like a good idea on the service but lacks fundamental fairness. Taxation should never cut in to the ability of a person to provide for their most basic needs, and those who are fortunate enough to reap the greatest benefits from our economic system should have a greater share of the responsibility. In accordance with this I would seek the implementation of a three tiered flat tax. I would also seek to identify non productive behaviors that distribute wealth upward, not by productivity, but through control of markets and money flow. The non productive upward distribution of wealth takes hard earned money out of the pockets of working Americans and needs to be stopped. Special taxes, not applicable to most Americans, would be applied to those behaviors in order to discourage them and repair the damage they cause. Every American deserves a chance at the American Dream, and our taxation system should help, not hinder, their efforts. Check out Will’s Voting for the American Dream and Business Model for Corporate Social Responsibility. I would also commission comprehensive studies to look for innovative ways of taking income tax out of the hands of the federal government while still allowing it to function effectively and meet its obligations. I do not know if a workable strategy could be found to do this, but it is worthy of exploration.

2. Massive reform to the U.S. banking system. The current Federal Reserve System gives private banks far too much influence over U.S. monetary policy. Thomas Jefferson so feared the role of banks in the U.S. economy that he uttered the following words:

   “The [privately-owned] Central Bank is an institution of the most deadly hostility existing against the principles and form of our Constitution…if the American people allow private banks to control the issuance of their currency, first by inflation and then by deflation, the banks and corporations that will grow up around them will deprive the people of all their property until their children will wake up homeless on the continent their fathers conquered.” Current events are bearing out his words.

   There are those that would like to return to the gold standard, but I do not believe this is an accurate reflection of our productivity. Our money supply needs to be tightly affixed to a set standard that allows it to maintain equilibrium in the world currency market, thus protecting the buying power of private citizens. I suspect that government and private banks are guilty of abuses in this area. Our currency needs to be released in a manner that provides strict safeguards to keep private banks, corporations, and the government itself from skimming off the top. I would assemble a team of visionary economists to advise me on how best to go about this reform. Also check out Will’s ideas on the Financial Bailout and Slaves to Debt.

3. New ethics rules to eliminate special interest money from the political process. Money and politics do not mix. A system that requires candidates for Federal office to raise millions or even hundreds of millions of dollars from private contributions, compromises them from the very start. A system would be set up whereby candidates are blind to the identity of their financial contributors, and strict penalties would be imposed if a candidate took money directly from a contributor. Tight limits would also be imposed to the total amount of money a candidate would be allowed to receive as an added precaution. In light of the strict financial cap, Presidential candidates who are able to demonstrate broad based support for their candidacy, based on pre-determined criteria, would be given a forum upon which to make their case to the American people. The parameters on this process would be constructed so as to insure that leading candidates from independent parties are included in the process and are able to run on a level playing field against Republican and Democratic candidates.

4. Establishment of new vehicles to remove ineffective politicians.
   The voice of the people must be first and foremost on the minds of our elected officials. We honor them with the offices which they hold to represent our needs and our dreams, and they must be held accountable. We deserve not only good leadership, but great leadership, and I would work to make sure that happened, but giving people the ability to get rid of ineffective leaders. For further information on this subject check out my earlier post, Removing Ineffective Politicians from Office.

5. Reform the Electoral College to give citizens a greater voice.
   I do not believe that the Electoral College works as intended. The number of electoral votes that is carried by powerhouse states such as California, Texas, New York, and Florida dwarfs that of most other states in a winner takes all contest, with no consideration of those who cast the losing vote (http://en.wikipedia.org/wiki/Image:US_Electoral_College_Map.PNG) . The electoral system was initially implemented to keep the voice of smaller states from being overwhelmed by their more populace neighbors. The voices of the smaller states have dimmed as our population as migrated toward coastal states and large population centers. I believe that we might be better served by constitutional reform that breaks those votes down into their respective congressional districts. Smaller states and individual voters, would have a greater voice in government as a result of this action, and events such as the 2000 Florida recounts would have had significantly less effect. In light of the fact that this would be a Constitutional reform, it would have to be considered with great care, and with great attention to the voice of the people and the states.

6. Establishment of a decentralization program.
   The federal government has an important role to play in the well being of its citizens, but it was never intended to wield massive power over the states. Centralized power in heavy concentrations is an ideal environment for waste, inefficiency, and corruption. The federal government should lead, but it has no business managing the states. I would carefully examine each federal program, cut wasteful programs and spending, and return the implementation and management of several of them over to the states, provide training, and ensure that they had the resources and skills to do so. In a decentralized environment, some states would develop innovative ways of dealing with problems that centralized control does not allow. Effective strategies could be observed and taught to other states and the government as a whole would benefit.

   My administration would be one of innovation, guided by the people, visionaries, and philosopher kings. It would seek to make sure that the voice of the people was heard above all others. Each committee and cabinet would have a citizen’s advocate who could be depended on to be strong and impartial, who would interface with real people and represent their voice in each meeting. It would not be afraid to take bold new steps, but would do so with due caution. It would lead through inspiration and post these words prominently throughout the walls of the White House, so as never to forget its responsibilities:

“We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness. — That to secure these rights, Governments are instituted among Men, deriving their just powers from the consent of the governed, — That whenever any Form of Government becomes destructive of these ends, it is the Right of the People to alter or to abolish it, and to institute new Government, laying its foundation on such principles and organizing its powers in such form, as to them shall seem most likely to effect their Safety and Happiness.” – The Declaration of Dependence

What is the Greatest thing you could do, if you were President?

**Special thanks to the Dan Carlin’s common sense podcast Episode #136 Confronting The Hydra for his insights on Medicare and military spending.

Health Care in America…What’s the Solution?

• Of the 19 advanced nations on earth, the United States ranks last in health care.
• Last in infant mortality.
• Last in disease treatment.
• Last by nearly all measures of public health.

But first in one area…cost.

We have created the most expensive health care system in the world and forty-seven million people don’t have the insurance to pay for it.  This is not just a problem of the indigent.  Most of these millions live in households led by full-time workers. We pay more for prescription drugs and health care than any other nation on Earth and we are the only developed nation that doesn’t offer even basic services to all. Most of us will spend 90% of our lifetime health care resources in the last 6 months of our life, prolonging our misery and fighting off the inevitable.

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Taken from Will Marre’s,
The 4th American Revolution: What We Can Do Together

DOWNLOAD PDF: Healthcare in America

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For ten years I served as a leadership consultant to one of the premier hospital and health care systems in America.  It was extremely well run but what I saw was complexity and conflict beyond reason.  It’s no wonder our health care system is broken.  What’s amazing is that it works at all.  It’s time for a change—big change.

We are constantly told that a free, open market in health care is a good idea because it gives us choice, attracts the best and brightest into medicine, and creates needed economic incentives.  So, if it’s so good, why aren’t countries that have universal health care clamoring to create free market medicine?  Maybe it’s because U.S. medical costs just continue to rise and are now taking up nearly 20% of our gross national product.  That’s a waste.  And we aren’t getting quality care we think we are paying for.  More and more doctors are saying our nation’s hospitals are among the most dangerous environments their patients can be in.  The annual number of medical errors made to injured patients is estimated to be in the millions.  The American Medical Association estimates over 800 people a day die in American hospitals due to avoidable mistakes.  That is more than an “oops.”

Recently I was in a small café and saw a plastic canister with a photocopied picture of a child in need of a $300,000 surgery to remove a brain tumor.  The canister was for donations.  The child’s parents worked at the café and everyone, their co-workers and regular customers, were pitching in to raise money.  These hard working parents made too much money to qualify for Medicaid, but too little to have adequate health insurance.  Two thoughts went through my mind.  First, their only real option was to have the surgery and declare bankruptcy.  (Stratospheric medical bills not covered by insurance cause about half of American bankruptcies.  That’s right; lots of us have health insurance and still go bankrupt.)

This is absolutely nuts.  We live in the only first world country in the world where full time, hard working people have to beg for money to take care of their children’s medical needs.  We all see it.  Homemade donation canisters for uncovered medical expenses are on store counters in every town in America.  Think about it.  The only countries where people have to beg for money to be cared for is us and countries run by thieving dictators who don’t care about their citizens.  Too strong?  You might not think so if you were trying to raise money for your child.  Or you had your medical insurance claims denied based on a trivial technicality, which also happens to millions of us each year.

So now the Democrats this presidential election are talking about universal health care.  Obama promises universal access to health care by expanding coverage for children and Medicaid for the poor and requiring companies to offer insurance to their workers.  Republicans think Obama’s plan is too expensive and want to use the power of the marketplace to make health care more affordable (Obama and McCain Health Care Plans).  Huh?

Talk is cheap.  What’s outrageous is the cost.  Empty promises mean nothing.  The solution isn’t schemes to make it illegal not to own health insurance or new programs to cover prescription drugs which will cost presently uncalculated hundreds of billions of ours and our children’s tax dollars a year.  Of course access to quality health care is essential to 21st century civilization.  That’s a given.  But it’s the wildly escalating costs of health care that must be stopped.  The health care system is a crazy hodgepodge of old processes, individualistic doctors, inefficient hospitals, financially driven insurance and drug companies, non-sensical regulations, and bewildered, frightened and frustrated patients all competing in a jungle of self-interests.  The result is not efficiency and quality predicted by a free market of voluntary exchange but the opposite.

No one wants old-fashioned socialized medicine. We need to reduce costs, increase access, and stop as well the rise in needless illness. Turning the health care system into the post office is not the answer.  But neither is just creating tax incentives or health savings accounts. We need to work on the cost side as much as the universal access side or we’ll all be in financial intensive care.  We already know we can reduce costs by using 21st century technology, specialized hospitals, health courts, and suspending incompetent doctors.

The marketplace is experimenting with some interesting ideas on how to increase access to health care to more people. Walk-in Minute Clinics use nurses to treat 80% of illnesses that people go to doctors for in one tenth the time at 1/3 the cost.  Wal-Mart and Target are selling $4 prescriptions.  These market experiments are good but insufficient. So how about this? What if every U.S. citizen became part of a single group?  Private insurers would have spread our individual health risk across 300 million people.  What if we took the profit motive out of health insurance?  Suppose health insurance companies were non-profit and what if managers and employees of these non-profits were individually rewarded for both efficiency and effectiveness; the most people well served for the least amount of money so that more people could be well served.  What if, as some have suggested, we were individually responsible for paying for our own health insurance premiums that only covered up to $50,000 in claims?  Then suppose we taxed both the suppliers and consumers of products with corn syrup, transfats, and similar poisons and we used that money to pay for claims over $50,000.  Why?  Consider this; in 1960 no one in the world ate an ounce of corn syrup.  We also had very little adult onset diabetes.  Today we eat 63 pounds of corn syrup every year and have screaming levels of diabetes.  Heart disease is our current number killer because we eat food that treats our arteries like bacon grease treats a drainpipe.

Such a health care program would shrink our own personal insurance premiums, and we’d make the producers and the consumers of stuff that is killing us pay for the health crisis they are accelerating.  Would it solve everything?  No, but at least it’s a new idea.  And we need lots of them.  What are your ideas?

So, what’s the solution to health care?  Leadership.  To let the entrenched, special interests of the medical infrastructure keep the status quo a few more years until they retire rich is a travesty.  Can we make a large-scale universal medical care system work? If we use common sense, flatter bureaucracy, and refuse to reward greed, we can revolutionize the insurance industry, drug development and health care delivery systems.  All it takes is the will to make it so.  Isn’t it time?

What’s the Greatest Thing We Can Do?

Question #9: What’s the solution to health care for all Americans?

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