The House today votes on repealing and replacing Obama
Care.
I watch the proceedings with much horror as House Republicans
are repeating the mistakes the Democrats made in 2010.
House Democrats in their attack on the bill decried
the lack of bi-partisan input and missed opportunity to repair rather than
repeal the law. They invoked the traditional scare tactics of years past: Armageddon,
millions will die, thousands will go bankrupt, heartlessness, devastation,
inhumanity, and so on. They accused
House Republicans of mean-spirited intent and of shifting 600 billion dollars
to the wealthy (whose money it was in the first place). They lament that
Republicans were shoving the legislation down their throat, just like they had
done in 2010 to the Republicans. Thus completing the oscillation cycle.
It is not over yet. Senate Republicans will get a
chance to fix some of the glaring problems of the House bill. They will have
the opportunity to include Democrats in the process, thus ending the
revolving cycle. The nation needs a bill on which people can bank on for the
long haul, not from legislature to legislature.
Polarization and animosity, not just in Congress, but
also in the electorate, are preventing us from addressing the healthcare issue in a more united and
collaborative manner. Republicans’ victory will be Pyrrhic and
shortsighted without Democrat involvement. The current zero-sum
approach used by both parties will take us in the direction of a lose-lose
outcome. We need a win-win solution!
Obama care was flawed… surging costs, lack of
competition in some States, failure by some exchanges, and so on. But it had
some good elements too: coverage of pre-existing conditions, inclusion of
dependent children until age 26, and inclusion of several procedures previously
uncovered, to name three.
To make my point clearer, this blog includes a bit of
theory. I hope it helps illustrate the conundrum we find ourselves in, of our
own doing, I might add.
Here Comes
the Theory
In graduate school, I learned about the inescapable
laws of organizations. To oscillate or to
advance. These laws are followed by specific principles and guidelines.
Oscillation is about moving from one place to another,
any advancement is followed by reversal. Like in a rubber band, we discover
that when you stop stretching it, it goes back to its original position.
Advancement, on the other hand, is about moving from one place to somewhere
else, a movement that achieves end objectives.
Organizations often neutralize their own success. How?
Success in one area causes difficulties in another area. By focusing on
individual pockets of success we can miss overall nullification. This has been
the Achilles’ heel of Obama Care.
Every eight years or so, we witness an oscillating
pattern of success. We elect a president from one party only to precipitate the
eventual election of a president from the other party. As the pendulum swings,
the nation starts to shift its priorities and policies. But, it is often a sign
of another impending election win by the opposing party. The rubber band effect
maintains continuity, but it avoids or makes it tough to achieve real change or
to engage in real change.
Research on organization behavior shows that you
cannot fix an inadequate structure. You simply cannot move from inadequacy to a
suitable one. Fixing means taking “the what is” and repairing. Redesign, on the
other hand, means you start from scratch and rethink your basic premises. You
cannot fix an oscillating structure so that it will be a resolving one that
advances.
Problem solving has a built-in tendency to oscillate.
Why? There is a huge difference between demolition and architecture. Problems often
are accompanied by a biased view. Solving problems is very different than
preventing them. The healthcare debacle is a great illustration of this
concept.
We need unifying principles. Common purpose permits
better coordination of countless activities. Purpose is intangible, and often,
beyond words. Good intentions are not enough. It takes a good design to tie the
parts together. Like all masterpieces, designs are governed by unifying
principles. Plaques on the wall are not the solution. Rhetoric or slogans
trivialize the most meaningful concepts because they rely on watered-down,
simplistic declarations.
We need dominant values that displace competing,
lesser values. This requires leaders
with clear substance, and a shared approach to reducing conflict and
facilitating shared goals. Unifying principles can lead to fairer ground rules
and fewer games. Successful presidents
such as Lincoln, FDR, and Reagan, over the years have demonstrated the power of
this concept.
Leadership theory also teaches us that not all
problems are created equal. Some problems are easier than others; other problems
might even escape resolution.
Leaders are confronted with two types of problems: tame and wicked. There are solutions for tame problems. Experts can be
brought in to find them and implement them. There are no solutions however for
wicked problems. No experts to whom to turn. The problem is so complex that no
one seems to know how to successfully solve it.
The healthcare problem is such wicked problem. It affects 20% of the
U.S. economy and impacts different people in different ways. It is a very
costly and controversial program indeed.
What Next?
Best way to solve wicked problems is through
bi-partisan collaboration. Both parties need to start from scratch and come up
with a set of unifying principles around the role of government in the
healthcare of its citizens. This
exercise provides guidance as to the super ordinate goals to be achieved, followed
by specifications to follow when architecting the proposed bill. Evaluation is measured by how well the initial objectives
are met, not by secondary data points.
Unless we break the cycle, in four or eight years we
will revert or oscillate back to Obama Care, only to be followed four or
eight years later a return to Trump Care. You know, the wide pendulum swing
that keeps the electorate confused and angry.
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