I have voted for Republicans in past elections. I have voted for Democrats in past elections. More accurately, I have voted for individual politicians who have been affiliated with both major parties.
This surprises a lot of people with whom I come into contact since they equate my general level of social liberalism and service with political liberalism. This is an error. I am a social liberal and political conservative to a large degree. My political conservatism comes from my long affiliation with the Law of Unintended Consequences Party. I do not think that throwing money at problems is a good substitute for forethought, prudence, ingenuity and creativity (hasn't ever worked for me so why should I think politicians would do better). Nor do I think that emotional spur of the moment responses to events constitute good governance. Fiscally dubious programs with ill defined goals and absent milestones rarely result in good long term value. Deciding on governance for me often involves balancing rights, responsibilities, security and costs.
Lately I have found myself voting for more Democratic candidates. Some people believe that is because I have become more liberal. Not true - the Republican Party has become less moderate. My beliefs and values have remained pretty constant. The parties have shifted. The best metaphor I can come up with is imagining walking a straight line along the beach during shifting tides. Sometimes my course results in dry feet and other times my feet are in the water. The Republican tide is at low ebb to my way of thinking so I find myself walking along the Democratic line most of the time at this juncture in history.
That bastion and archetype of modern conservatism, Ronald Reagan, turned that tide in my opinion. Many people like me believed in fiscal conservatism but that was not what Reagan and company were peddling. They simply chose to promote run away spending on different priorities. That isn't conservatism to me. It wasn't any love affair with the Democrats for me, it was just that their run away spending was more in line with my social liberalism. Thinking that you know what's best for everybody else is often one of those hackneyed recipes for disaster - not caring is often worse.
I say these things as a preamble to my next thoughts. The reform of healthcare. As one who knows from years of experience, this system must change. It isn't broken - that would imply that it ever was good in the first place. It wasn't. It is a disgrace. It has worked as long as it has because clinicians have worked around the problems. That no longer is an option. The thing is collapsing. My social liberalism considers it immoral that we have uncovered citizens denied coverage in this country. My fiscal conservatism worries that we'll break the bank with the wrong approach.
New adminstrations know that the first 100 days of office is where they often get the most things done. Problem is that you cannot reform a 2 trillion dollar a year industry touching the lives of all Americans in 100 days. To think otherwise is why Clinton failed before. It cannot be done well. A rapid emotional response will result in a poor program. I think we see a lot of that now.
But it must be changed.
Here's how.
The National Healthcare System Experiment.
Year 1: Identify the true thought leaders in healthcare delivery and their actual reform models.
Year 2: Fund as many as 10 different experimental care delivery models in 10 different States by enrolling volenteer uninsured and uncovered populations supervised by the GAO. Party leadership agrees to abide by the science aided by public pressure to do so. The goal is to identify the best way(s) to deliver care for the long term. The payment structure can follow after we really know what we should be paying for.
Year 3: Repeat the experiment in 3 different States with each of the 3 top performing models. Performance involves metrics of access, compliance, outcome assessment, and cost.
Year 4: Implement the winning model in all 50 States' Medicaid/Medicare programs.
This surprises a lot of people with whom I come into contact since they equate my general level of social liberalism and service with political liberalism. This is an error. I am a social liberal and political conservative to a large degree. My political conservatism comes from my long affiliation with the Law of Unintended Consequences Party. I do not think that throwing money at problems is a good substitute for forethought, prudence, ingenuity and creativity (hasn't ever worked for me so why should I think politicians would do better). Nor do I think that emotional spur of the moment responses to events constitute good governance. Fiscally dubious programs with ill defined goals and absent milestones rarely result in good long term value. Deciding on governance for me often involves balancing rights, responsibilities, security and costs.
Lately I have found myself voting for more Democratic candidates. Some people believe that is because I have become more liberal. Not true - the Republican Party has become less moderate. My beliefs and values have remained pretty constant. The parties have shifted. The best metaphor I can come up with is imagining walking a straight line along the beach during shifting tides. Sometimes my course results in dry feet and other times my feet are in the water. The Republican tide is at low ebb to my way of thinking so I find myself walking along the Democratic line most of the time at this juncture in history.
That bastion and archetype of modern conservatism, Ronald Reagan, turned that tide in my opinion. Many people like me believed in fiscal conservatism but that was not what Reagan and company were peddling. They simply chose to promote run away spending on different priorities. That isn't conservatism to me. It wasn't any love affair with the Democrats for me, it was just that their run away spending was more in line with my social liberalism. Thinking that you know what's best for everybody else is often one of those hackneyed recipes for disaster - not caring is often worse.
I say these things as a preamble to my next thoughts. The reform of healthcare. As one who knows from years of experience, this system must change. It isn't broken - that would imply that it ever was good in the first place. It wasn't. It is a disgrace. It has worked as long as it has because clinicians have worked around the problems. That no longer is an option. The thing is collapsing. My social liberalism considers it immoral that we have uncovered citizens denied coverage in this country. My fiscal conservatism worries that we'll break the bank with the wrong approach.
New adminstrations know that the first 100 days of office is where they often get the most things done. Problem is that you cannot reform a 2 trillion dollar a year industry touching the lives of all Americans in 100 days. To think otherwise is why Clinton failed before. It cannot be done well. A rapid emotional response will result in a poor program. I think we see a lot of that now.
But it must be changed.
Here's how.
The National Healthcare System Experiment.
Year 1: Identify the true thought leaders in healthcare delivery and their actual reform models.
Year 2: Fund as many as 10 different experimental care delivery models in 10 different States by enrolling volenteer uninsured and uncovered populations supervised by the GAO. Party leadership agrees to abide by the science aided by public pressure to do so. The goal is to identify the best way(s) to deliver care for the long term. The payment structure can follow after we really know what we should be paying for.
Year 3: Repeat the experiment in 3 different States with each of the 3 top performing models. Performance involves metrics of access, compliance, outcome assessment, and cost.
Year 4: Implement the winning model in all 50 States' Medicaid/Medicare programs.
2 comments:
You're proposing politics by SCIENCE! NOOOOOOOO!!! We can't be incorporating experimentation into our political arena! It's just un-American.
/sarcasm
Seriously, no politician would go for it...
The problem of applying scientific method to social change is not the science. It is the social.
People are not patient. People are emotional. People are not logical. They respond to lights and sounds that excite and entertain.
If the governors of our society could act apart from the people, they could apply systematic methods to governance.
Unfortunately, they must please the people. Often they cannot avoid the temptation to feather their own nests before doing "good." I am sure many are highly skilled in the arts of justification.
Our highest hope will be a ponderous and badly managed system fraught with waste, but that in the end will do some good.
At least it will fit well with everything that has come before.
Mike
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