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.