Flipping the Script

As the country grinds to a Covid-induced halt, and President Trump descends from existential threat, to absurd clown, to likely defendant, the rest of us are tasked with our personal survival through spring, or longer.  Hibernation is natural for many mammals during winter’s darkness and cold, yet we humans are better at romanticizing hibernation than practicing prolonged seclusion.  Distractions conceived to ward off anxiety and depression are, I have learned, a simple enough concept, but soon fall victim to the banality of repetition.  And, while I embrace the theory of the “present moment” as the only one that matters, when desperation takes up residency in the now, as it has for too many Americans, breathing deeply can slide into hyperventilation.

Watching the news as a go-to distraction is of little help when the message is, we’re all gonna die.  Old movies turn out to be just that: old. Hallmark movies?  Little more than a sugar high. Reminisce about lost freedoms and good times?  I don’t recommend going down that rabbit hole.  And, our spouses, partners, family members, and even pets (if they haven’t bailed on us already) look askance at us with that gaze of simmering contempt as their eyes speak without words: “Oh, you again? You’re still here?”  Do you think “stay-at-home” comes with the permission to share your flatulence as loudly as you can?  Winston Churchill gave the best advice: “When you are going through hell, keep going.”

Alas, the earth still spins its way, day by day, to a new tomorrow.

As for earth, I expect it is wishing for an asteroid to rid itself of humanity but, for the time being, we are stuck with each other in a fateful embrace of dual threats: nature’s virus to humans, and human’s toxic dependencies that are assuring the extinction of nature.  Oh, joy!  This is our centennial (perhaps millennial) test: can we come together to defeat a pandemic and leverage that new-found unity to halt, then reverse, climate change?  Can we save ourselves and nature too?  The pandemic is, in many respects, our audition—a training-wheels deal.  If we can’t defeat it, we have little hope of affecting climate change.  We may as well load up the Yukon and move there—to the Yukon.  (I hear new real estate brokerages are opening there every day.)

Dear reader, we need to flip the script, and soon. We need to summon our inner entrepreneur and reconceive threats as opportunities and work to morph our weaknesses into strengths.  We need to reimagine our world and the role(s) we play.  Lord knows we have the time, now we just need the will.  I used to teach budding entrepreneurs and aging executives the same thing: that success is based in intelligence, resources, and passion; that you can win with two of three as long as one of them is passion.  You can be smart or well-funded, but if you lack passion—intensity—you will not prevail.  To that end, I have some thoughts for America.

The recent election revealed an America at war with itself; a cold civil war, but a war nonetheless.  Biden won the presidency, but had no coattails down-ballot.  Trump lost (yes, Donald you are a LOSER), but voters down-ballot preferred Republicans.  So, Biden’s challenge is to largely ignore the 30 million voters on each of the far right and left—the core audiences of FOX and MSNBC—and try to satisfy the 90 million in the middle.  That is his only path forward.  Political provocateurs with absolutist exclusionary slogans need to take a holiday.  Self-righteous condemnation has no place in public discourse, whether it emanates from the right or left.  We can’t afford extremes; we must live in the middle lane.  Boldness? Certainly.  Win-lose certitude?  Absolutely not.

To that end, as we wish him well, we need to shift our focus from Biden’s challenges and reimagine how we can affect the production and distribution of public goods—without the Federal Government.  Public goods are things like healthcare, education, transportation, and communication systems.  Things better managed through collective interest than personal.  They are things that, if we all have access to them, make us both collectively and individually better off.  They are best considered through the lens I call collective capitalism: a hybrid of collectivism for the common good and the efficiency of capitalist regimes that reward the highest and best uses of available resources.

Let’s take healthcare as an example of a public good we might tackle on a regional basis.  What if states grouped themselves into like-minded affiliated networks?  Like networks of blue states and red states.  What if the governors of Washington, Oregon, California, Arizona, New Mexico, and Colorado got on the phone and formed a public-option based healthcare network?  What if those same governors demanded a return of tax dollars and authority from the Federal Government and tasked their brightest minds—from the public and private sectors—to design and implement a new healthcare system for the residences of their states?  Red states could form their own networks based on their own particular ideological preferences.  A healthcare system based on every person for themselves?  Abortion illegal? Defund Medicaid? Go for it. (And watch people flee.)

The reality is this: in a cold civil war, our Federal Government provides little hope for solving our problems.  To be clear, I am rooting for Joe.  However, reality is screaming in our faces; the Federal Government no longer serves our interests—even on life and death issues.  Perhaps seeking solutions through regional affiliations will exacerbate division, but affiliation may be more realistic than unification, and we need to solve some basic problems now.  Regional competition based in service to citizens rather than politicians may be just what we need to bring honesty back into the process.

People like Mitch McConnell should not be a factor in the health and welfare of children in South Central Los Angeles.  Alexandria Ocasio-Cortez should not determine what crops a farmer plants in Iowa.  However, they exert their influence because we have placed these decisions in their hands.  Shame on us.  We have both asked and allowed all three branches of our Federal Government to take responsibility and assume authority for way too many issues.

Frankly, we need to get off our asses, get our proverbial shit together, and control our own destiny.  The Washington monument is just that—a monument.  It is not a beacon to light our path to the future.  That path begins at home.

By |2020-12-18T16:16:49+00:00December 3rd, 2020|General, The New Realities|0 Comments

Trillion Dollar Decisions

There are two trillion dollar decisions bouncing around our nation’s capital these days: healthcare and Afghanistan.  While each significant in their own right, they are chapters in a larger story: the re-definition of American identity.

Ironically, one initiative intends to improve and save lives while the other wages death and destruction—achieving as yet unspecified objectives.  Both cost about the same within their projected ‘lives’ per the Congressional Budget Office and estimates leaking out of the Pentagon and the White House. While no one is suggesting it is an either/or choice—the sublime notion of fiscal discipline notwithstanding—these choices illustrate what is likely a transformational time in American history.  Do we continue to assert our hegemony in the global system (with or without the cover of national security), or do we turn inward and take care of our own house?

Even if we succeed at each—admittedly a foolish assumption—even if we actually take our healthcare system back from the stranglehold of the health insurance industry, pharmaceutical companies, state-based fiefdoms, malpractice attorneys, et al, and achieve affordable, accessible healthcare for all; or that we crush al-Qaeda, the Taliban, build a democracy in Afghanistan, or whomever/whatever it is we’re fighting for today, is it worth two trillion dollars and thousands of lives?  Are hegemony and/or healthcare the right priorities?  What about education, energy, climate change, economic development, scientific research, human rights, international law, or the dependability of the global financial system (to name a few other choices)?

The larger issue is what makes a nation powerful and successful today—cherished by its people and envied by the world?  Which of the laundry list of initiatives collectively succeed in meeting this standard?  Which America will emerge in the next five years, ten years? What does it mean for our children and grandchildren? Will there be any trillions left for them to spend? Will they even be spending dollars?  Are we staring at the sunset of the American empire or its re-birth?  Do our leaders understand the enormity of the moment?  Is Obama the next Teddy Roosevelt, FDR, or Reagan; presidents who transformed our national identity and kept the American dream alive?  Or, are we destined to fumble our way recklessly forward toward a crisis where we are defined by powers, elements, and interests beyond our control?

The moment is Obama’s, notwithstanding the march of members of congress to the lectern to grab their seconds of fame, or the pundits who fan the flames of absurdity to claim the title of last loudmouth standing.  They will still be there second-guessing everyone when this sequel is written.  It is time for Obama to sit alone and contemplate the larger issue: how to keep America on top, cherished by her own and envied my many more, keeping the American dream alive.  The answer may or may not include healthcare and Afghanistan.


By |2017-05-27T16:29:04+00:00October 30th, 2009|General|0 Comments

Healthcare: What to Read

The healthcare issue is complex (to say the least), which is a significant contributor to its vulnerability to subterfuge. For those of us interested in understanding it – who want to know what the fuss is all about and maybe even form our own informed opinion – I offer two articles and one study I believe tell you all you need to know.
They are:
1) “The Cost Conundrum” by Atul Gawande in The New Yorker, June 1, 2009, available at www.newyorker.com.
2) “How American Healthcare Killed My Father” by David Goldhill in The Atlantic, September 2009, available at www.theatlantic.com.
3) “Bending the Curve: Effective Steps to Addressing Long-Term Health care Spending Growth” by 9 smart people, available at www.brookings.edu/reports

By |2017-05-27T16:55:35+00:00September 6th, 2009|General|0 Comments

Mr. Brooks ‘n Me

My wife has often suggested, after reading David Brooks’ column in the New York Times, that there is a synaptic circuit—a telemetric loop that runs between Brooks’ mind and mine.  In his column today, “Let’s Get Fundamental” (www.nytimes.com/2009/09/04/opinion/04brooks.html) he argues, citing David Goldhill’s piece in The Atlantic (see “Let the Numbers Speak” post) and a research report from the Brookings Institute, that it is time, as I suggested (see ‘RIP-Teddy’ post), to go for it—all out reform—to swing for the fences.

Brooks is more eloquent than I and has just a few million more readers.  I hope he gets his message across before it’s too late.  I hope he gets his hour with Obama to offer guidance before next week’s address to Congress.  (I’m relatively certain I won’t.)  I hope we actually do accomplish reform rather than, as Brooks warns, just “essentially cement the present system in place.”  But, maybe I hope too much.  And, maybe Obama is all hoped-out.

As Brooks, I, and the Brookings Institute study agree: the problem is fixable.  The resources are there.  The financial imperative couldn’t be more obvious.  The outstanding question: do we have the will?

By |2017-05-27T16:58:09+00:00September 4th, 2009|General|0 Comments

Healthcare: Let the Numbers Speak

If pictures are worth a thousand words, then numbers are worth five hundred. Here are a few numbers to provide perspective on the healthcare debate.


Surely we can do better than this…

From David Goldhill’s article in The Atlantic:

Number of deaths each year from patients infected while in the hospital: 100,000 (more than twice than from motor vehicle accidents).

Number of deaths from blood clots following surgery: 200,000.


Exploding costs…

Also from Goldhill in The Atlantic:

Percentage of Medicare & Medicaid spending to total government spending in 1966: 1%. Today: 20% (and rising).

‘The federal government spends 8 times more on healthcare as it does education, 12 times what it spends on food aid … 30 times what it spends on law enforcement, 78 times what it spends on land management and conservation, 87 times what it spends on water supply, and 830 times what it spends on energy conservation.

The cost of power…

From Matt Taibbi’s article in Rolling Stone:

Amount of financial support from the health sector each of the republicans in the senate’s ‘group of six’—considered the de facto key actors in the senate on healthcare reform—have received.

Grassley – $2,034,000.

Snowe – $756,000.

Enzi – $627,000.

By |2017-05-27T17:03:13+00:00September 2nd, 2009|General|0 Comments

Healthcare: Time to Address the Real Question

There is a great scene in Disclosure, the 1994 movie starring Michael Douglas and Demi Moore. (Okay there’s more than one.) The one I’m referring to is when Douglas’ character, who has been compromised by Demi Moore’s character via a sexual liaison, realizes he is solving the wrong problem. Douglas is quietly implored by an undisclosed supporter to “solve the problem.” Douglas, of course, thinks he is solving the problem but subsequently realizes it was the wrong problem. When he finally figures this out he prevails. It all reminds me of how the Democrats and the White House are approaching the healthcare debate: they are addressing the issue by arguing about the wrong things—albeit ably—and allowing a discussion about what is and always has been a public good to be framed in a construct of an individualistic meritocracy.

In today’s Wall Street Journal, Thomas Frank identifies the same strategic error in “Why Democrats Are Losing on Health Care.” Frank argues it’s “the big questions that are tripping them up.” Understanding that the very nature of insurance is a cooperative subsidized construct; that there’s no such thing as a truly individualistic healthcare choice; that the connection between merit and healthiness “is almost as risible”; and that “healthcare is not an individual commodity to be bought and enjoyed like other products … that the health of each of us depends on the health of the rest of us.” (Just wait for H1N1’s return this fall.) In short, the Democrats have fallen into the wrong discussion—a battle they can win and still lose the war.

The larger issue is (see 8/31 post), who are Americans? Do we believe in public goods, like security, safe water, law enforcement, etc.? Answer: yes. Is healthcare a public good? Answer: yes. When most of us have too much healthcare, some have none, and the providers are rewarded for over-serving those of us who have insurance—bankrupting our future—everyone loses in the long run. And the long run isn’t so far away.

It’s time to put the larger questions on the table and stop playing able technocrats. It’s time to agree on who we are and what we believe in. Then, the question of ‘how’ gets much easier.

By |2017-05-27T17:00:42+00:00September 2nd, 2009|General|0 Comments

Healthcare: A Matter of Identity & Destiny

In the midst of cries of socialism and death panels on one side, and predictions of national bankruptcy and moral appeals on the other, lies a tug-of-war of historic proportions to settle a larger issue: who are Americans?  American identity has always been a contested issue.  Lest we forget there were both ‘Federalists’ and ‘Anti-federalists.’  Occasionally, a seminal issue bubbles to the surface that re-fashions identity. Sometimes they are moral issues like slavery, at other times they are political issues like imperialism (circa 1900), and other times economic—New Deal or no deal?  The current debate on healthcare is such an issue—not just because of its underlying moral nature—because it defines our future economic stability.

Ironically, when we ignore the town hall loudmouths and fears of collapse-by-taxes we find a challenge in healthcare that is imminently fixable.  It is, quite simply, a big distribution problem: who gets what, when and how and, who pays?  The good news is there is plenty of money in the system.  We know this because we see other countries accomplish more than we do with much less money.  We know that what they do is scaleable too—size is not an issue.  As actuaries know, size should actually allow us to do better for less.  We also know that we have plenty of non-financial resources: hospitals, doctors, technicians, equipment and drugs.  And, even though they may be unevenly distributed, remember: there is plenty of money in the system—we can fix that too.

The fact is many of us have too much healthcare—are over-served—while others have none.  Many of us have ready access to medical care, albeit with many unnecessary tests and treatments.  Others have none and/or are forced into overcrowded emergency rooms, which makes the system even less efficient.  Those of us who are over sixty-five, employed by a medium to large company, can afford it on our own anyway, or are a child who qualifies for S-CHIP are covered.  Some forty to fifty million others (depending who you believe) have none.

So, all we need to do is hire a bunch of those IBM-ers to sort out a new distribution system, right?  But, that’s not really what we are fighting about.  If we fail it will be over a larger question: who are Americans?  We must decide if we are a nation that believes our government should design basic support systems that address the bottom rung of Maslow’s Hierarchy of Needs, or are we a nation that believes exclusively in self-determination and private enterprise?  Is healthcare a utility like power, water, and security; or, is it an industry free to serve its customers for as much money as the market will bear?  Most of the world sees Americans as selfish and powerful.  Are they right? Or, are we a misunderstood nation of rugged individualists?  The reality is messy, as realities are.  We are neither.  We are somewhere in-between.

Unfortunately, staying the course assures disaster.  One thing we cannot continue to afford is the financial reality.  We have thirteen trillion dollars in current debt and fifty-three trillion in unfunded liabilities (principally from healthcare and social security).  We know we can’t meet those obligations, especially as the states that have been buying our debt are already pursuing other investment strategies away from the dollar (like China). We may not agree to smooth out our distribution system with a team of IBM-ers, but we must deal with at least this: we must get more for our healthcare dollar by restructuring the ‘over-served’ problem.  The patient must have a stake so discipline is introduced into the system.  Patients must question tests and procedures and maybe even embrace the concept of diet and exercise.  Those of us who have healthcare must step back from our sense of entitlement and realize that we do not need all those tests and that maybe there is something fundamentally wrong with all those ‘ask your doctor about _____’ advertisements.

We may not decide to serve those who have none, although I hope we are better than that. (I think the IBM-ers can prove all can be served for less.)  But, at the minimum, we must decide we cannot continue to serve ourselves the way we have.  If we don’t, our identity may be defined for us—as a one-time superpower that met its demise at its own hand; still selfish, but not so powerful.

By |2017-05-27T17:06:18+00:00August 31st, 2009|American Identity, General|0 Comments

RIP—Teddy Kennedy

The eulogies are over.  The limos are back in their stables.  Now what?  The end of an era, or business as usual?  Was Kennedy a master lawmaker without whom Congress cannot function, or a guy who rode the culture of Camelot and family money for all it was worth?  Does it matter?  Is this, as Matt Taibbi suggested in the latest issue of Rolling Stone, the summer we will point to that marks the moment when our government lost us forever – by blowing healthcare reform – by escorting the elephant of social and financial deficits out of the room in hopes that somehow they enter an arc of self-correction?

Or, is this the moment when we realize we’ve got to do a work-around; when we come together to excuse our government from its illiberal internment and break a few rules to solve a huge problem.  Is the colossus of insurance providers, drug companies, and their legions of lawyers too big to fail, or face reform?  Is anyone, including President Obama, up to the task?   Will he be, as Paul Krugman asks, the next FDR or Jimmy Carter? As with Kennedy’s death, does it matter?

The tipping point (a la Malcolm Gladwell) is staring us right in the face.  Societies progress in a ragged and messy line—through phases of stability, revolution, chaos, and reformation. America is no different—maybe even the poster child due to its openness—its grip on liberty.  Healthcare may be the fulcrum between order and disorder.  Just take a look at those town hall faces. Time to hang on tight.  It’s going to get much uglier before we know where we end up.  One thing is for certain: doing nothing, or too little, is as dangerous as doing the wrong thing.

I say, it’s time to swing for the fences – while there are still fences.

By |2017-05-27T17:10:15+00:00August 30th, 2009|General|0 Comments
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