By Kevin Meyer
There are so many lessons in the health care reform fiasco that I almost don't know where to start. I apologize in advance if I offend some politically-sensitized readers, but if you make it to the end I hope you'll find my point to be balanced. Sort of.
How about a new administration and Congress that campaigned on transparency and change trying to ram through "reform" with a 1am vote on a bill that even most Democrats weren't allowed to see until the very last minute? One built on concepts that a majority of the country, from both sides of the political spectrum, strongly oppose – albeit for different reasons. (right-leaning source) Naah… too easy.
How about such extreme budget shenanigans as having taxes start years before any benefits are paid, and then calling it "balanced." Or a 21% decrease in doctors fees that will be impossible to impose, or cutting $500 billion from a program like Medicare that is already projected to be insolvent. Not to mention late night payouts to senators from Nebraska, Louisiana, and elsewhere to effectively buy votes. And they have the unmitigated gall to call business and insurance companies corrupt? (left-leaning source – note the balance!) Naah… once again, too easy.
Maybe I'll tackle those tempests some other day. For now keep in mind that I'm a middle-of-the-road kind of guy. A fiscal conservative and a social liberal and as such I can't identify with either major party. And unfortunately due to some extreme family medical situations I'm intimately attuned with the current state of health care and know it definitely has to change – and soon.
While watching the health care train wreck taking place inside the Beltway, I couldn't help but be reminded of a piece our friend Dan Markovitz penned over a year ago on kaizen versus kaikaku, which I then recapped in a post that once again offended the sensitivities of some readers. I'm trying to refine that ability, one way or another.
Here's how Dan compared kaizen and kaikaku:
Kaizen is boring and laborious. Kaikaku is sexy and exciting. Kaizen is your spouse of 15 years. Kaikaku is the smoking hot blonde on the barstool next to you.
It's the difference between hitting a single and hitting a homer.
They'll both get you a run, but singles are a lot easier to come by
than homers. And you're less likely to strike out.
Small incremental improvements versus the hail mary. There's a place for both… perhaps.
Now think about that in terms of the health care "reform" witches brew being cooked up in Congress. There was so much that both ends of the political spectrum agreed on. Eliminating the ability to deny coverage based on pre-existing conditions. Eliminating caps on annual and lifetime benefits. A host of opportunities around a focus on effectiveness and outcomes instead of being paid by procedure. Many more people need access to insurance in some form. Maybe even a realization that tort reform is necessary to reduce defensive medicine.
Instead our representatives decided to go for the hail mary, kaikaku. And what happened? An exclusion allowing denial of coverage for pre-existing conditions until at least 2014 as a compromise to get votes on another aspect, which was already a compromise to get votes on yet another aspect of the issue… you get the picture.
Basically even the easy stuff that everyone agreed on isn't part of the final bill, or has so many loopholes that it is worthless. Not to mention 100+ new commissions and agencies and panels to supposedly create efficiency to manage the whole convolution. Some like to say all politics is local… and then push for centralized control. Go figure.
What would have happened if a kaizen approach was used with health care reform? Start with the easy… a single simple bill outlawing the denial of coverage for pre-existing conditions. Easy slam dunk. Then a bit more difficult but still an easy win to eliminate benefit caps. And so on and so on. Sure at some point they'd become more difficult and rancorous as crazy ideas like public options were tackled, but major positive change could have happened. And happened months and months ago.
Instead of sitting here today with a bill that will increase costs (unless you buy into the fancy "accounting") and eventually drive us further toward banana republic status, decrease choice, tax the companies creating medical technology innovation, without really helping very many people while hurting the parts of the system that are working… we could have had major progress via many small steps.
From that position of already having achieved positive change, change we really could believe in, positive change created by initial bipartisanship success, we'd be trying to figure out solutions to the tough angles.
Unfortunately now we'll spend (no pun intended) the next generation picking up the pieces from this monstrous piece of… failed kaikaku.
Emmer says
The old saying goes that we get the leaders we deserve. What did we do to deserve this?
Jim Deucy says
Brilliant, Kevin. I would add that the kaizen method also requires a true analysis of the problem so that the right solutions can be developed. In this case the “leaders” started from a position that everything associated with healthcare was broken, so the baby is being thrown out with the bath water. An incredible medical device innovation engine is one of them.
There are so many good parts of our system. Unfortunately once again, such as in our schools, we’re reduced to a focus on the lowest common denominator… and calling that a “solution.”
Bruce Baker says
You wouldn’t get a single Republican vote on “a single simple bill outlawing the denial of coverage for pre-existing conditions”, it is only on the table after the negotiation a public option.
Dan Markovitz says
One thing that’s occurred to me in watching this train wreck of a health care bill is that we never had the most important, and most fundamental, conversation first: do we believe that as a society we have a *moral* obligation to provide health care to every citizen (or resident)?
Not to be overly simplistic, but I think this was the biggest mistake the government made. Congress has been quibbling over the mind-numbing details of the bill in large part because there’s no clear public mandate to get it done. If we had that popular mandate, then the money and the accounting would be (relatively) trivial. And to your point, it could be done in small steps.
Jamie Flinchbaugh often talks about how a small difference in the A3 problem statement makes a huge difference in how the problem is solved. In this case, the first question should have been, “Should we provide health care for everyone?”, not “How do we pay for health care for everyone?”
Jamie C says
I’m actually more toward the left of the spectrum, but the process of creating this travesty really disturbs me. The arrogance, lack of concern for the views of their consituents, special back room deals, and the desire to cram through anything for the sake of a political timetable really makes me wonder what change I voted for. It may not be a true right, but we need to find a way to provide universal health care as a simple moral obligation. Unfortunately this bill will do more harm than good, and I fear it will really affect the so-called representatives of my end of the spectrum come next November.
Pete says
Clearly this was change simply for the sake of change, which violates a key aspect of kaizen – not to mention a key aspect of the “first do no harm” doc creed. Real change requires a thoughtful analysis, hansei, of the current situation. When did that happen in this process? Or most any political process for that matter? That’s why we get regulation slapped on regulation slapped on policy and wonder why it doesn’t work out smoothly. Not to mention what happens when you tack on Cornhusker Deals and the like.
Truly disheartening to see how far we’ve fallen in the short span of a year.
Pete2 says
We have the best government money can buy and this health care fiasco illustrates that perfectly. Our self-centered re-election obsessed representatives are mostly interested in keeping the best “job” they could ever have. Let’s see: no increase in SS payments due to no inflation, but increase in Medicare deductions from payments due to inflation; and Congress votes themselves a pay increase due to – dare I write it? – inflation. Our representatives are interested in feathering their own nests, not in solving problems.
JR Earl says
So if this goes through, how do we change the trajectory of government so that it creates real positive change instead of cow-towing to political expediency? Otherwise we’re setting ourselves up for more and more of this crap.
Until recently I thought some of the comparisons of any government program to “the DMV” (which is actually run well in several states) was unfair. Now… not so much. This health care reform deal was sickening to watch. Something has to change – not necessarily in party or philosophy, but in how change is created.
Tony says
Just a couple comments:
1. The best commentary I’ve seen is on Jay Cost’s Horse Race Blog http://www.realclearpolitics.com/horseraceblog/
2. If you allow coverage for pre-existing conditions, then it isn’t insurance. Can I buy car insurance that will fix my car’s pre-existing accident damage? Home insurance to rebuild my house that’s already been destroyed by fire.
If pre-existing conditions are covered, then I can drop my insurance until I get sick.
Maybe the current model of health insurance doesn’t work, or needs some serious tweaks. But the current House & Senate bills do nothing to fix the system.
Dino Morson says
Allow me to offer a view from the Great White North (aka – Canada). It is a bit comical watching your legislative members struggle with the health care fiasco. Either you do what we and the Brits did years ago, go full tilt into a government funded (& managed???!!!) health care system or give it up and let the 14% of the population continue to struggle with no health insurance and another 14% struggle with inadequate health insurance. This half & half system that is being pushed won’t work, you will still have the have nots and the haves.