Health Care Reform Leaves Plenty of Time to Prepare for Change

We all know the clichés surrounding change. Change is hard. Change is another word for opportunity. Change is inevitable. Change hurts. Change is for the best. Etc., etc. Put simply: change, whether for good or bad, is uncomfortable. And under the legislation passed by the House of Representatives yesterday, change is coming to the health care industry. In fact, when one-sixth of the economy is involved, change is coming to our society.

The anxiety this change is causing is not surprising. Health care is personal and critical. The legislative process and political context in which this health care reform bill passed has done little to inspire confidence. For many readers of this blog, whose career and livelihood is inextricably tied to the health insurance industry, the changes coming are especially unsettling.

So a certain amount of hyperventilating is to be expected, both in the comments section of this blog and beyond. Over the next several days I’ll be posting information about some of the details of the reform package and offer my observations on how this will impact the industry and, more specifically, professional health insurance brokers. But for now, my advice is, to take a deep breath and try to maintain a sense of perspective.

Keep in mind, nothing is going to change tomorrow. Or next week. Or next month. Most, although not all, of the reforms take effect months and years from now. There will be plenty of time to digest the meaning of the health care reform package and to prepare for its impact.

Not only will there be plenty of time to digest and prepare for the coming changes, there is plenty of time to influence what those changes are. Congress is still considering the clean-up legislation. And once these laws are signed, there’s still much to be done. Judges, judges, regulators and state lawmakers will refine, define and mold the provisions of the bills. This is an evolving process. Organizations like the National Association of Health Underwriters are well prepared to promote the viewpoints of its members.

One final bit of reassurance for those overstressing about health care reform. It takes the form of two interconnected truths: 1) things are never as bad as they seem to be; and 2) America is strong enough to muddle through challenges, mistakes and worse.

America survived Senator Joe McCarthy and his witch hunts in the 50’s. We survived the anti-war demonstrations and the campus riots of the 60’s. We survived President Richard Nixon and Watergate in the 70’s. We survived mullets in the 80’s. America survived the scandals of the 90’s. We survived unfunded, deficit-busting tax cuts for the wealthy in the ‘00s. (Two of them, actually). The reason? None of these events were as cataclysmic as they seemed to be at the time. And America is strong enough to survive such problems.

To claim that health care reform marks the end of America’s greatness is illogical and, based on history, wrong. Opponents called Medicare and Social Security socialistic, yet the country is sound and those programs are an established part of what’s considered the norm. Critics claimed President Franklin Roosevelt’s New Deal was going to result in the destruction of American values. Didn’t happen.

At least once per generation some economic swing is described as dooming the financial wellbeing of that generation’s children and grandchildren to an inner circle of financial hell. Well take a look around. We are the grandchildren of those economic policies. And we’re still the strongest economy on the planet.

The unknown is a scary place because, well, it’s unknown. And as human beings we have a tendency to extrapolate from where we’ve been through where we are to where we’re going in a straight line. The Glenn Becks of the world love to play this game, tying reasonable regulation to the advent of socialism, Nazism and communism. But the Glenn Becks of the world are more interested in selling soap (or gold, as the case may be) than in presenting sound and reasoned arguments. To fully understand the silliness of this simplistic, irrational thinking, I strongly urge you to spend 15 minutes watching Jon Stewart’s skewing of Glenn Beck on The Daily Show that aired on March 18th. Not only is it hilarious, but it superbly outlines the danger of Mr. Beck’s sloppy illogic. (There’s a couple of annoying commercials you have to get through before the show starts, and it’s somewhat risqué, but thedelay before he gets to the chalk board is well worth it. This may be the best quarter-hour of political satire I’ve every seen).

America is a resilient country. We are creative, hard working, and dedicated. We work things through. The health care reform package President Obama will sign into law tomorrow (even as improved by the side-car legislation that will likely arrive on his desk in the next few weeks) creates problems galore. It does some good things, too. For those taking notes, the status quo presents problems aplenty, too. And it also does some things well.

Problems are never solved, they’re just replaced with new problems. And as those new problems emerge we’ll address them.

The same holds true for health insurance professionals. We’ve faced change before – and not all of it for the better. But we continued to provide meaningful services to our clients, demonstrated our value and expertise, and we’ve succeeded. And we will again.

Vacations Almost Over – It’s Time to Get Real

The August vacation is almost over and not a moment too soon. Vacations are supposed to be a time of relaxation, recharging, maybe even contemplation. It’s a break from the norm; a chance to get a new perspective on things.

Sometimes.  Then again there’s the vacation from hell where everything goes wrong and you can’t wait to get back home. The hotel that looked pretty in pictures turns out to make the Bates Motel look hospitable. And let’s not even get into the crowded airports and late flights. Such vacations are not about rest, their about survival.

When it comes to health care reform, August was more of the vacation as disaster variety. A month of demonization (fitting, somehow, for a vacation from hell), dark fantasies, and an ever increasing lack of civility. Instead of an opportunity for all sides to present their differing perspectives and to present persuasive arguments for their point-of-view we witnessed the Outrage of 2009. Sincere people whipped into a frenzy by those who profit from conflict and fear. It was not only a bad month, it was a sad one.

But that will soon be behind us. Labor Day marks the end of summer (at least psychologically if not astronomically). It will soon be time to get serious. Here’s my take on what we have to look forward in September. Some of these items are well publicized, others guesses, and still others the result of wishful thinking. As a whole, however, I expect this list identifies much of what is to come now that we’re done “relaxing.”

  • President Barack Obama will describe ObamaCare.
    According to the Associated Press, the White House is “considering a speech to spell out more details of his goals for overhauling health care ….” My guess is he’ll have to go beyond detailing goals and dive into specific on legislation. To date the President has been content to outline a broad definition of meaningful reform. There were advantages to this approach, but the downside is rapidly overwhelming those benefits. The Administration’s vagueness kept its options open, but allowed Congressional Committees to define the President’s health care plan in the public’s mind. The bills attacked during the various town hall meetings are Congressional proposals, not President Obama’s. The Administration needs to define “acceptable compromise.”  Otherwise opponents of change will continue to savage the process of reform, killing the purpose of reform without having to engage in a debate on policy.
  • The Senate Finance Committee will meet its September 15th deadline for issuing a bi-partisan proposal, or on September 16th we’ll see a Democratic proposal emerge from the committee.
    Senator Max Baucus, Chair of the Finance Committee, and his colleagues are to be commended for seeking health care reform that can gain the support of moderates in both parties. They have spent months working through both broad policies and minute details – hard work on easy issues, a herculean task when it comes to something as complex and controversial as health care reform. The time has come, however, to move on. They have created expectations that the fruits of their labor will be made public by September 15th. That expectation needs to become a reality. To date, President Obama has given them political cover by continuing to speak of principals as opposed to specific provisions. As noted above, however, that position is too tenuous to continue. If the Senate Finance Committee fails to bring forward a compromise plan before the President begins staking out firm political and policy positions their compromise won’t matter. If the Finance Committee acts first, however, the President can elevate their approach to the first proposal among equals. The most potent ordering of things is for the Senate Finance Committee to get specific first with President Obama following suit shortly thereafter. If handled correctly it would create a strong middle ground upon which moderates could take a firm stand.
  • The political attacks will continue and become more vicious …
    The Keith Olbermanns and Glenn Becks of the world have found a ratings magnet: vilify the opposition while rejecting any possibility that opponents might have a reasonable, albeit different, position. Demonizing opponents sells to those already on your side. As cable news blabbers have no need to make policy they are free to paint the world in deepest blacks and whites and “find their audience.” At the same time partisans on both sides are reveling in the fundraising bonus blind anger generates while, at the same time, proving their bona fides to core constituencies for future political efforts. As the August press coverage demonstrates, hate, slander, lies and fear sell. And there are plenty of politicians and media outlets willing to take advantage of this ugly reality.
  • … and the political attacks will become more subtle.
    At the same time the extremists will get even more viscous, lawmakers, who operate in shades of gray, will begin to prod opponents into compromises with stilettos as well as reasoned arguments. An example: Senior White House adviser David Axelrod’s claim that Republican Senators Charles Grassley and Mike Enzi have not acted in good faith during their discussions with Senator Max Baucus and other Senate Finance Democrats to produce a bi-partisan health care reform bill. The attack by Mr. Axelrod is both a means of assuring liberals that the White House is capable of playing hardball as it is of prodding the GOP Senators to continue negotiations.
  • The Status Quo is in for a beating.
    The only way to enact substantial change is to convince people the status quo is untenable. This is good news for reformers as the health care system’s status quo is untenable. Medical costs must be constrained or state governments and private businesses alike will be bankrupt. Families cannot live in fear of facing a choice between financial and health security. The medical infrastructure of emergency rooms and pro bono care cannot continue to handle their ever increasing burden. Advocates of reform will make this case repeatedly and in the harshest of terms. The resulting cacophony will be painful in many senses of the word, but it’s an inevitable part of the process.
  • Many issues will be in play, only a few will be discussed.
    Change will come, either thoughtfully and not. All Americans will benefit from a thoughtful approach.Such thoughtful reform includes tackling medical cost containment. Health insurance premiums, after all, reflect the cost of health care. Those premiums have doubled in the past 10 years, an unsustainable rate of increase. If we’re going to “bend the cost curve” as President Obama puts it, tough decisions will be required. Making those decisions is especially difficult in an environment when consultations on living wills is construed as creating death panels, but making them is essential nonetheless. Politically, however, lawmakers need a bad guy. So the public debate will focus on market reforms (Exchanges and public plans, pre-existing conditions and mandates to buy coverage) which permit the vilification of insurance companies while, hopefully, quieter arguments focus on cost containment. Hopefully, because if health care reform is to have any long term meaning, it needs to control costs.

By the end of the year President Obama will sign into law health care reform legislation. That final package may not look much like the legislation discussed at the town hall meetings in August, but it will dramatically change America’s health care system nonetheless. And when the raucous debates, political warfare and mongering of fear is over, when the reforms are signed into law but before the long process of making them work begins, hopefully there will be time for a real vacation.

Health Care Reform: Fear and Loathing

Health care is personal, important, confusing and expensive. No wonder so many people are upset at attempts to reform America’s health care system. The status quo may be broken, but the devil known is more welcome than the devil coming to town.

It’s especially scary for conservatives who look at the folks doing the reforming and are terrified. When they see President Barack Obama, Senate Majority Leader Harry Reid and House Speaker Nancy Pelosi they see liberals – actually they see LIBERALS. The kind their parents warned about. These aren’t fellow Americans with whom they happen to disagree, they’re “the others,” the socialists, the government building, boogie men of talk radio and a certain 24 hour news station. (And yes, this being America, there’s a 24 hour news station boosting fear of conservative boogie men, too).

It takes a giant leap to think that elected leaders in America are plotting to create a system with death panels that will impose euthanasia on seniors, make virtually every health care decision in the country, murder millions of children and much more. Yet those are the accusations made by former Governor Sarah Palin, Cal Thomas, Representative Virginia Foxx, and Representative John Shadegg. And many on the right take are predisposed to take these accusations seriously.

Then there are more legitimate controversies that health care reform impacts. For example, should health plans health plans be required to cover abortions? That’s a legitimate public policy issue although it’s often weighed down by political rhetoric that obscures the real issues.

All of this makes it easy for liberals to dismiss these concerns. They see the need for a public health insurance plan to increase competition, not drive private carriers out of business. Evaluating the cost and effectiveness of care makes common sense and sound economics. It has nothing to do with being intrusive. There’s nothing sinister about this approach, but conservatives view such claims with fear and loathing.

What we have here are two groups of people looking into the same room from different windows. What they see is colored by where they stand and the prejudices they bring to the view. Where one sees conspiracy and death panels the other sees common sense and prudent regulation.

This is more than just a fascinating glimpse into the human psyche and how it plays out in the public policy arena. It underscores the challenge facing those seeking change. They need to not just fashion a workable system, but they have to deal with the fears and suspicions of those who instinctively oppose them – fears and suspicions that are stoked for self-aggrandizement and profit by the Glenn Becks and Michael Moores of the world.

Then there’s the political element of this dynamic. Liberals can comfortably ignore the concerns of conservatives regarding health care reform. All they need to do is bring enough moderates along to build the majorities needed to pass their legislation.

But in American politics the pendulum swings. In 2001 the President was George W. Bush, the Senate Majority Leader was Trent Lott and the House Speaker was Dennis Hastert (just two years earlier it had been Newt Gingrich). Their view of how a public health plan should work – what it covers and who it benefits – varies considerably from the Obama/Reid/Pelosi view. Yet the greater the role liberals give the government over health care, the more control over issues like abortion conservatives like Bush/Lott/Hastert will have when they take power again – and eventually, they will.

Fear and suspicion, anger and foolishness knows no ideology. The left and right are equally susceptible to assuming and perceiving the worst in the actions and words of the other side. Both have paid cheerleaders to make stoke their worst predilections.

As lawmakers consider the impact of health care reform they should keep in mind the American political wheel turns. Eventually all of us watch our elected leaders with fear and loathing. And the greater the influence government has on health care the more vitriolic the suspicion, anger – and the danger.