February 25, 2010

• The last best hope for Health Care?

  Or just a waste of everyone’s time?

  Today President Obama is holding a Health Care Summit with Republicans and Democrats in Congress.  It’s six hours long, televised on C-SPAN.  The idea is that Obama wants to try to work out all the differences on Health Care and come up with something that can pass.

  I’ve been listening to this for the last three hours. The summit is supposed to be six hours long and they are currently taking a break to take a House vote.

  I strongly believe in this idea. Get everybody in a room and work something out in public, with everyone there. Make an agreement no matter what it takes and then do something.  Not just sharing talking points but make concrete progress.

  But really what I’m seeing is not very useful. Largely the problem is that the structure is way too organized. Everyone is getting a chance to speak for a set amount of time and they’re all spreading talking points. Then everyone politely waits and then responds and then they move on. All to keep the overall meeting within the six hour time frame.

  I think that’s not the way it should be done. In fact I think it should be the opposite of that. If someone makes a controversial point they should stick to it until a solution can be resolved. No moving on. No giving other people a chance to speak. Just deal with it. Don’t let up and don’t stop even if they have to deal with the one damn point all night.

  For example at the very beginning one of the Republicans made the point that this bill increases people’s premiums according to the CBO. President Obama then said “no it doesn’t” and explained why there might be confusion on the issue.  And then they just moved on both still in complete disagreement with one another over whether the bill increased premiums or not. And of course that means the American public is EQUALLY still divided on the issue.  The fact has not been established. We just get two opinions and who you respect most will be the person you agree with.

  That’s idiotic.  This is not a mater of opinion. There is a TRUTH as to whether the bill will or will not increase premiums. We should be able to establish our very best guess as a country as to what that truth is. So they should get that fact nailed down right there. No moving on. You get out the bill turn to the right pages in question, read it, go over it, make it certain. Call up any experts you need to. Bring them in if need be. Determine if it is true or not.  And hammer at it until you get a result. All calls should be made in public too. At least make as compelling and powerful a case for each side as you can possibly make and then let people have their disagreements. Preferably you force the person who is wrong to acknowledge where they are wrong.

  And then put it up on a board or a checklist of some kind.
  Problem 1. Does existing bill increase premiums.
  Resolved: Yes it does increase premiums or No it doesn’t increase premiums.

  Then you move on to the very next point and do the exact same thing. Go through every single relevant controversial issue. You can go point by point through every single Republican proposal that might get incorporated into the bill. You can go point by point through every single Republican objection to what’s currently in the bill. Determine the truth of it if there is a truth to be determined. Otherwise illuminate the details of the question in as great detail as you possible can and then determine where everyone stands on it.

  If necessary get a vote of everyone there on each issue by party.

  Don’t go “in order”. If nobody has any thing relevant to say about a particular issue, don’t call on them to discuss the issue. If somebody says something idiotic and off topic cut them off immediately and force them to move back to the topic at hand.  This little speech approach makes it just like campaigning for Health Care. It’s each side advertising for their beliefs, not analysis to come up with real answers.

  And don’t go for just Six hours. Go until the job is done. Set specific progress goals. And based on how much progress you make determine if whether another meeting is needed. If you don’t make any of the minimum progress goals in a single meeting then you damn well stay there until you DO make that much progress even if you have to be there all night.

  Have one of these sessions like every other day until you’ve hammered out a health care bill. All of it in the open. All of it in the presence of C-SPAN cameras. Nobody else in the room except the experts called to give testimony, the senators and representatives present, and the American people. 

  When it’s all over you have a set of undeniable facts that everyone agrees upon and a set of ideas that are agreed can be incorporated and a set of ideas that should be removed. You have everyone on record agreeing or disagreeing to those things. So you make a bill out of it. And then you dare anyone who was there to oppose it and reveal themselves to be a liar and a hack.

  It would get tricky at times. I’m sure somethings would end up getting tossed out at first. For example, I would fully accept that the individual mandate as currently conceived would get tossed at first since it is strongly opposed by the majority of the American people and I highly doubt most congressmen are secretly deep down in favor of it. President Obama himself campaigned against the idea in the primaries.

  But prior to that hopefully they’ll have established universal agreement that you can’t have strong insurance regulation without getting more people coverage and they’ll also have established universal agreement that strong insurance regulation is absolutely necessary for the future of health care.

  So then they’ll have to run through suggestions as to how to do that, either by FIXING the individual mandate somehow or replacing it with some other system.

  If you go the Fix route then you have to establish exactly what is wrong with the individual mandate. Is it too expensive? So establish whether insurance premiums can be dropped to the point that people can afford it. Is the problem that the I.R.S is enforcing it through a tax? OK, well if that’s the case there are ways to fix it. Like for example the Japanese have a much better individual mandate where people aren’t taxed for not having insurance but just have to pay back premiums. That makes a lot more sense to me than the current individual mandate so it’d be an idea they should discuss and reject or accept it.  Or if the problem is that people would have to buy from private insurers which they don’t trust. Well one idea to fix that is to have a Public Option that people can buy instead.  OR you can just let anyone buy into Medicare which is itself a kind of public option.

  If all suggestions for how to fix the individual mandate fail they should go on to trying to figure out an alternative that solves the same problem. One way is just to automatically have the government pay everyone’s insurance costs or health care costs directly. That’s called Single Payer. Another idea would be to remove the individual mandate and instead try and have a stronger employer mandate and expand medicaid or medicare coverage for the unemployed. Alternatively you could just make everyone who is unemployed an automatic employee of the state and eligible for the same group insurance all current government employees get.  Or instead you could always go the more individual route and try to find ways to somehow give people incentive to buy from private insurers even though they don’t trust them and even when they’re healthy.  I’m not sure how you could do that, maybe you could give them benefits on their social security or lower taxes in some way. Or some other ideas.

  In any case, they should go through all the ideas one by one and deal with every issue with them and rank them in order of overall popularity.

  Of course I realize this is largely what Congress probably already did when they came up with the bill. But the difference is nobody trusts that congressional process. Everyone thinks it was done through wheeling and dealing and cheats and bribes. I’m sure every health care reporter in the country already has their “The N deals that killed Health Care Reform” article already written in anticipation for its eventual defeat. I know I’ve already thought about my blog entry on the same topic.  But this meeting should be a way to absolutely avoid those articles. It’s not starting from scratch but it is doing an open comprehensive unchallengeable process that is visibly uncorrupted by external influence. Ideological differences might drive disagreement and that’s perfectly fine but we’ll know that everyone is bringing their own thoughts to the table and not consulting with some lobbyist who tells them what they should think or say or relying on some unaccountable aides or political operatives who care only about the good of their party.

  And hence you get the job done. One way or the other.

  Well that’s my ideal way to handle it but then I’m not President or in Congress. And even my system would have problems. What would be to stop one party from just refusing to continue and walk out for example? Hopefully shame. But you never know.

  Still, I think this six hour meeting even if it is mostly for show is a lot better than just letting the whole health care reform effort die until 2012 at the earliest and more likely 2016 or possibly even longer forcing us to suffer even longer with a system that is falling apart. At least they can try to get some agreement and at least try to explain their differences in beliefs. And maybe afterward they’ll be able to create something that the American people will support and believe is at least an attempt to make their lives better without so much bullshit and scare tactics marring the entire process.

  It may be a small tiny pitiful looking hope, but I do think it’s the last best hope for Health Care reform. And if it fails, I guess we’ll all be on our own. But at least we’ll have established that unequivocally and we can all move on. Hopefully Congress will have better luck fixing some of our other serious problems.

  • 1:56 pm
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