A Critical Mass of Thinking on Health Care Reform

Recently I joined a small breakfast with a senior Democratic Senator who lamented the "lack of critical thinking" on healthcare reform. The intellectual pendulum on how to reform healthcare swings a wide and uneven arc. This is especially true in Congress, with visible factions existing even within the Democratic Caucus. Gathering momentum in any direction seems almost impossible. We need more than critical thinking -- we need a critical mass of thinking.

This notion of "a critical mass" is akin to a widely accepted framework, a mutually agreed upon intellectual infrastructure on which people from different political parties, geographies and backgrounds can agree. These core operating assumptions serve as a launching pad for additional, more nuanced policy discussions.

This critical mass of thinking does not necessarily gather quickly or easily -- in fact, it often takes decades to accumulate. In 1947, an article in Foreign Affairs magazine by George Kennan, Deputy Chief of Mission of the United States to the USSR and better known as "Mr. X", established a foundation that would be built upon for the rest of the century, informing policy makers, academics and members of the military through the 50's, 60's, 70's and 80's to when I worked on the Senate Foreign Relations Committee in 1989. There was indeed a critical mass of thinking on many of the core foreign policy questions of our time. Everyone agreed that there were too many nuclear weapons in central Europe; everyone agreed that Communism was bad; everyone agreed that politics stopped at the water's edge. These foundational assumptions, among others, enabled the negotiations and Senate passage of major arms reduction treaties with the Soviets, SALT I and SALT II, and led to treaties reducing conventional ground forces in Europe. The critical mass of thinking on foreign policy facilitated bipartisan support and helped to launch thoughtful and complex treaties that had a major impact on international politics.

Every so often, a critical mass of thinking can be generated by extraordinary leadership in a relatively short period of time. President Reagan managed it in the 1980s, culminating with the 1986 tax bill - the largest tax cut in the history of the United States, which passed with sizeable bipartisan majorities in both the Senate (67-8) and the House (282-95). With his straight talk, thoughtful ad campaign, savvy targeting of Democrats in swing states and districts, personal appeals from the Oval Office, and the facts on his side, he convinced the American people and Congress that taxes were too high. The critical mass of thinking on tax levels enabled the historic Reagan tax cuts. (Obama's latest media efforts clearly reflect Reagan's and other Presidents efforts to leverage the bully pulpit of the Presidency).

So, back to the task at hand: gaining a critical mass of thinking on healthcare reform. The Framers of the Constitution assumed people would break into factions, and built a legislative body designed to cultivate and foster a critical mass of thinking among these factions. The Senate is especially built for this purpose, where Senators hold much more individual power and the majority can't simply impose their will on the entire chamber as is commonly done in the House. And on that side of the Capitol, Chairman Max Baucus and the Senate Finance Committee are currently engaged in putting the Framers' thoughtful legislative structure to work.

Chairman Baucus and the Committee are working through 500 Republican amendments, holding hearings and voting on each of them. And, in the midst of all of the noise on health care reform, an interesting thing is happening: they may be developing a critical mass of thinking. While most of these amendments were supposed to mock Democrats and score political points with the Republican base, these hearings are actually providing a legitimate forum for a thoughtful discourse on health care reform, a noted departure from the town hall screaming matches and shout-downs of August.

Hearings work when smart people, people with real world experiences, industry professionals and consumers who share a sincere desire to make change for the better, gather and share ideas and listen to one another. These hearings are doing just that. Of course, it remains to be seen if this mass of critical thinking moves beyond the walls of the Committee and onto the floor of the Senate when the full body debates healthcare reform. But the discussion alone should give us hope.

Comments

[rad21]

Here is some "critical-mass thinking". Insurance companies are too busy making profits - excluding people with pre-existing conditions and dropping them when they are sick. They waste healthcare dollars through extravagant compensation packages for top management; and hiring an army of actuaries to risk-assess individuals they cover. Medicare has greatest variation in population with risks - from very healthy to sick, and those with multiple pre-existing conditions. Yet all in Medicare pay the same for the insurance. Overhead cost for Medicare is 4%; and 15%-25% for private insurance.

Due to multiple health insurance players in a "market place", none have the desire to provide healthcare in an organized manner to the community they serve. A public system provides greater coordination and responsibility with individuals held publicly accountable and "where the buck stops".

The new healthcare system should deny non-emergency care (including ER visits) without a healthcare card (preferable) or cash down-payment. Thus all will be 'forced' into healthcare. The former payment system, entails a primary care provider for better preventive and follow-up care.

Among lies perpetuated by private insurance industry: They subsidize costs of govt programs. Healthcare cost in the US is twice / person compared to peer countries. Insurance companies are not subsidizing govt. costs. They, in cahoots with the hospitals, are improperly managing healthcare and its costs; and sticking it to the captive consumers.

This is done with the political blessings (a.k.a campaign contributions) of states' health and insurance commissioners.

[wildedge]

There's something profoundly wrong about the third paragraph of this article ("This critical mass of thinking does not necessarily gather quickly or easily" etc.). First, it assumes the Cold War was a good thing, and offers as evidence that it brought about treaties limiting nuclear weapons and American troops in Europe - phenomena that would not have happened by for the Cold War - basically, without Cold War thinking we would never have een able to limit Cold War thinking. - huh?!
And frankly, the Cold War may have been historically necessary, but little good came out of it, it bankrupted Russia and came close to bankrupting us.
But a deeper problem is the undertone of the paragraph; what Hoopes is really suggesting is that given time, "critical thinking" among Beltway insiders produces a consesus among Beltway insiders, and this gets things done, which is a good thing.
I'm sorry, but NOT.
The problem is obvious - Beltway insiders are largely out of touch with what most people experience in their daily lives, what their values and aspirations, and problems, really are, and so cannot address either the needs or the wants of the people - so the people get niether, yet the insiders pat themselves on the back for a job well-done - meaning they are no longer representative of the people.
As I say, the problem is obvious - to all but a Beltway insider such as Mr. Hoopes..

[kdp59]

BIG issue happening RIGHT now!!!!

has anyone else gotten their health insurance renewals yet?

I was just told that my company's plan will go up between 25-35% and that has been the AVERAGE increase this year.

I have also been told this by other company owners, who have health pans and have rad the same is being done for people with individual plans as well.


anyone else have any input on this?


IF there is no way to keep premiums from raising THIS high between 2009- 2012....we can ALL forget having ANY health insurance!!

only governement workers and those on the dole altready (Medicare and Medicaide) will have any.

Compnies will drop or cost shift to the point that employees cannot afford it........

individuals wil NOT be able to afford coverage at those types of premiums no matter HOW much tax credits the middle class gets.


add it up.....

family coverage now----- $13,000/year
30% increase in 2010-----$­16,900/yea­r
30% increase in 2011-----$­22,000/yea­r
30% increase in 2012-----$­28,600/yea­r


sure the insurance companies are not worried about covering eveyone...LOL.

we better either ahve a valid non-profit for all to join in 2011....or there will be many more without insuracne coverage come 2012.


someone in Washington needs to get onboard with whats happening out there .

[NickHP]

Excuse me, but the high end tax cuts in the 80's launched us into a protracted period of shifting income from the middle and lower classes to the higher income classes. This has run up our deficits and increased the high/low income differences to historic levels. Whatever Reagan's merits, he was dogmatic in his economics. And thus ignorant in his decisions. His "straight talk" was bullshit, and I'm glad that period of social destruction is over.

The generational transfer of funds, begun with Regan's increased deficits, can only be seen as wasteful and destructive to the collective fabric of our society. Combined with a decrease in fiscal controls, we have subsequently encountered these recent economic bubbles.

[Matt Herlihy]

The only people who are "critically thinking" are those who at least support public option. Everyone else is bought for by the industry. That's the problem, not some kind of intellectual laziness.

And why is it that when everyone agrees on some kind of foreign policy that constitutes a critical mass of thinking? I think if anything that means people aren't thinking critically and everyone is just going along.

I also like how the author morphs ruthless, cutthroat politics in the '88 election with "savvy targeting of Democrats in swing states," as if that was really necessary to critical thinking.

[worldlyhick]

It's not a confusing or difficult issue.

When services are offered based on profits for some, some people are going to be excluded from obtaining those services, such as the poor or sick.

So is it more important to deny health care to people thus assuring the continued profitability of some industries (Insurance for example) or is it more important to not allow people to die from treatable conditions? What is so difficult about that?

[FishOfTheProletariat]

When Bush Junta invited Energy Transnationals into the White House to "discuss policy" with Cheney, was that a "critical mass" of thinking? When Republican Legislators had actual lobbyists, literally writing the legislation directly, while they made grand speeches about Patriotism, invoking 9/11... was that a "critical mass" of thinking?

So, as stated below, when Insurance and Megapharm industry shills, OUR elected representatives, refuse a seat at the table for ALL not for profit interests, and instead, spend endless days thinking up high sounding, philosophical justifications for doing nothing, or giving away the farm to their campaign "donors;" that must be "critical mass" thinking too.

No, it's not thinking at all. It is the very epitome of fascism. No thinking is allowed.

[chucktrotter]

"Hearings work when smart people, people with real world experiences, industry professionals and consumers who share a sincere desire to make change for the better, gather and share ideas and listen to one another."

Why were ALL concerned health care professionals blocked from the committee hearings? Why was the committee stacked with hayseeds representing such a small minority of America's populace? No mention has been made of the financial backers of key members of this august group of sold-out politicians. Where is my representation?

[deborahc]

If our Senators and Congressmen/women were subjected to the same health care/insurance expenses, limitations, hoops to jump through in pursuit of coverage for doctor prescribed treatments­/medicatio­ns, bankruptcies, denials and resultant deaths etc..., they'd put meaningful reform first rather than the business interests and profits of the health ins. and pharma. companies. As it is, reform is getting a few crumbs while the special interests are getting profit windfalls.

In all the countries that have universal, comprehensive health care, their governments made a commitment to provide it, then figured out how to pay for it, and then made it happen, whether that meant outlawing for-profit health insurance, imposing heavy, strict regulations on health insurance, or eliminating it entirely for all necessary care. In order to pay for comprehensive, universal health care it only makes sense to redirect the money we're already spending that is neither being used nor is needed for delivering care. But our government isn't willing to do that, because its priority is protecting the profits of the industries that enrich its members. And as long as that continues, we're screwed.

[ntmessage]

I am not so sure we need a critical mass of thinking in addition to critical thinking. 70% of the country wants reform via a robust public option. The wisdom of masses who experience the failures and flaws in the current system know this and critical thought does back this up, especially when considering we need better quality and less costs and that, we are, as a people no different to other counties who have mastered this innovation.

On the other hand, critical mass is selfish and “all about me” thinking that goes on in congress when cowards do not lead and want something to hide behind. Presumably, the same thing their lobbyists want at the continued risk of our country’s moral and financial stability.

If they are for a public option, they already have critical mass thinking backed by critical thinking. Some leadership from leaders would help. Tell your lobby you will take one for the real team. The American people. And maybe even grow a backbone.

[Binckeslaw]

Health insurance is tied to the loss of American jobs. Did you know that GM and Chrylser built more cars in Canada over the last few years than they built in the U.S.? Did you know that Canadian auto workers and suppliers lost a sliver in percentage terms of the jobs that American workers lost during the bankruptcies and restructuring? You can read about the concessions by the Canadian auto workers in the National Post...the equivalent of the Wall Street Journal in Canada. The reason why Canadian auto workers kept their jobs was because health care is provided by the Canadian government and not by the car companies and suppliers. A single payer health system will restore millions of American jobs. But then, as Charles Grassley points out, the private health insurance companies would be hurt. His concerns kind of makes one wonder about who Senators and Congressmen like Grassley really represent.

[PlaceboStudman]

Count me out of this critical mass

People lost me when I realized they couldn't tell or didn't know the difference between CARE and COST

We have been having a Health COST debate

I want Health CARE, whatever the price

[sixyfivepercentwater]

I'm 100% with you on this. This debate is like going to the store and haggling with the cashier over price before you've even picked out what you want to buy. All the indices of health care success - infant mortality, general life expectancy, etc. - are abysmally unacceptable in this country. Of course most of us don't need statistics to know we're getting absurd "care" from our HMO-drone "doctors."

[PlaceboStudman]

Just remember, a doctor, whether controlled by HMOs or the AMA, is only ever as good as the medicine and technology (what some of us call REAL Health care) they provide, and that comes directly from BigPharma and the FDA, through the AMA to doctors

[MighteeAphrodite]

People do know the difference between cost and care. For many, cost prohibits care.

Many have no health insurance. Try visiting a doctors office as a self-pay. For many, the pcp is the emergency room, and that cost is passed on to those with insurance as premiums increase with no appreciable increase in benefits . Many of those with insurance are underinsured, which also increases the cost of care.

So yes, cost is a problem and since many of us don't barter chickens or knitted sweaters in return for an MRI, we pay the middle-man to get that service. The insurance industry is profit driven and seeks to disperse risk.

Who loses. Not only the chronically ill, but also the underinsured, uninsured and insured.

The health care industry fails us in terms of cost and care. Insurance industry abuse is only one part of the problem.

But we must start somewhere, then peel the rest of the onion.



Be well.

[PlaceboStudman]

And I simply have a different starting point, because I dont see any poiint in paying a dime or a nickel or a penny for some of the dangerous poisons that pass as Health Care in this world. We can have "the best health care in the world" compared to other countries, but that isn't saying much when other countries are still trying to figure out how to get clean water and decent sanitation services.

I'm just not comfortable with giving people chemo and radiation, or a heart medication that causes renal failure, or an antidepressant that causes suicide.

If others are fine with that level of care, fine. But count me out

[Tim303]

It would still be nice to look at the costs, though. What is your problem?

[rad21]

This is fine and dandy! But are you personally prepared to pay the price for that care? Or is it the current thiking that "I was million dollar care" (every thing done) even if not / marginally beneficial, with someone else paying the tab.

[PlaceboStudman]

I am effectively terminally ill. I have had the "there's nothing more we can do for you but make you comfortable" talk with my doctor, who says that, if I am lucky, I have somewhere between 5 and 10 years left (at 36), and that any further medical intervention has just as much chance of hastening my death as doing nothing, so I have chosen to do nothing

So, yes I am fully prepared to pay the price for 36 years of the care I have received, when the medications and procedures I've endured for those 36 years to maintain my life due to a disability (spina bifida) will ultimately cost me my life