I appreciate and agree with most of the sentiments expressed in this comment, HOWEVER:
First and foremost I think HCR must pass. That more then anything is important to me because there are 30 million people at stake here. Because more then anything I view this as foot in the door, not some overall perfection.
And on that topic history has shown us that often our first attempts are rather pathetic and imperfect. But what is important is to get the idea enshrined into law and from their it's easier to improve on what is currently in the law.
Secondly I think the PO is a good idea but even as it is currently is written it is not worth 'dying' over.
Third, I enjoy Turkana's call to action diaries. I may think that the odds are next to null but you never know unless you try. What I do not enjoy is the insults, the parroting of GOP memes and so on. And yes calling the bill crap or useless without the PO is a GOP meme because the easiest way to kill this bill is to call it that.
(bold added to item#2)
HOWEVER, I must add that the PO is equally important and equally urgent, and let me explain why ...
PREFACE
I do agree with this comment above, which someone made last week in a somewhat heated debate, but there is far more that needs to be said than his comment suggests. In other words, my response is: Well, yes and no. This is wise, on one part (in terms of the Political Legislative Process), but naive on another part (in terms of Industry/Corporate Operations). Namely, it is naïve in its simplicity, because the deeper dialogue is where the real work for true reform is needed, and where the dangers reside, which is why so many progressives are, I believe, validly up in arms expressing great concern about the lack of commitment towards the PO. And, this is why even Kucinich took such a controversial stand, someone whom we all know is most certainly NOT an Insurance Industry shill, and further, is far more aware of the political issues of KILLING THIS HCR LEGISLATION than most of the bloggers on dailkos. In other words, we must not shy away from the detailed debate, in fact, the debate is the most important part of this (learning) process. And, with this in mind, I am diving headlong into the heart of this debate.
NOTE: In an effort to make this lengthy diary palatable/accessible, I have organized it into an outlined textbook format (with interspersed salient quotes) and even included a Table of Contents in my tip jar. I do hope this is helpful. Be forewarned, this is an involved, in-depth, comprehensive critical analysis, a Compendium of sorts. As might become evident, I do this for a living: I write industry reports, design corporate infrastructures, build Enterprise Information System (EIS), and write RFP responses for Fortune 100 companies, for numerous industries, including Health Care/Insurance. I am detail oriented, thorough, methodical, and admittedly, a bit OCD, which you can view as either a strength or a weakness. I think it's both, lol.
If you want a superficial inflammatory commentary, wherein I take a singular position and ignore the opposition, this ain't it. There is already enough of that, which has caused a heated schism here on dkos, and as discussed at length below, a costly rift in the Democratic Party today, centering around HCR and the PO, and the evidence of this is glaring, and this diary is an effort to address that schism/rift, and to correct it, by presenting an honest appraisal of the merits of each side of the debate. And, as is also discussed in painful detail below, people are not listening --- respectfully listening --- to the real and valid issues being raised, rather, they are reacting in inflammatory rage, rather than constructive critique.
--- This must stop! ---
It is okay and contributive (even valuable and necessary) to have differing opinions and perspectives, but to not listen to (and respect) the opposing viewpoint, that is a formula for ruin, and the Democratic Party simply cannot afford this -- not now, not ever.
In the corporate world, an IT Consultant's job is to listen to, and study, all sides of a situation/project, to weigh all interests in a patient evaluation, and then provide a recommendation: outlining all sides of the issue(s), identifying the Root Cause(s) of the problem(s), and the optimal solution strategy. This diary is of a similar nature. Forgive me for the length of this tome, it was unavoidable, and I believed the criticality of the HCR Legislation warranted it. Some of the critical writing/thought in this diary was previously posted as comments on various diaries; this is a comprehensive organized collection, with additional thought, to educate and elaborate. I don't post many diaries (but I comment often and often lengthy), and this is the first diary I have posted in over six months, and the only reason I am doing it now, is because it appears as if the HCR Legislation is about to pass, and I want to do everything in my power to make sure we don't make any critical mistakes, namely, like failing to also pass the PO!
Move Sooner, Not Faster
~ Aikido Proverb ~
0. INTRODUCTION
We are in the final days of The Countdown To Health Reform, and the last ditch push for HCR Reconciliation, and in effort to ensure that we do not loose sight of the forest for the trees, lest we cross the finish line and drop the ball on what many of us believe is a critical component of HCR, the PO, let me provide a dispassionate commentary on this Senate HCR Legislation, not just from the prevailing political legislative perspective, but also, from a Systems Integrator's point of view, as an IT Professional. As they say, "The devil's in the details," but before we dig into the details, let's review the political landscape ...
... to better know the direction of the wind ...
~ Leonardo de Vinci, in his letters ~
I. BACKGROUND
A.) The HCR rift surrounding the PO
As mentioned above, the PO issue has been at the heart of a heated rift within the Democratic Party, most especially, here on dkos, wherein, I believe, our priorities have become clouded by fears and misunderstandings -- but more than anything, by a lack of understanding. And, this rift is costing the Democratic Party the enthusiasm and motivation of the netroots nation. It is causing the progressive caucus to become disheartened due to loss of trust in the leadership. It has opened the door, even, for flames against our dear slinkerwink and nyceve, (amongst others), whom we all know have worked tirelessly for the cause of Health Care Reform, hardly folks who deserve such a disrespectful spirit, hardly folks who are corporate shills or represent Republican interests. I mean, these are the very two whose call to arms got over a million calls into Congress for the Health Care Summit. You can't buy those kind of results no matter how much corporate money you wield, and they did it, within a mere few weeks, and it cost them zero advertising dollars, in fact, they probably raised more funds as a fall-out of that campaign than they would have otherwise. And now, even, slinkerwink's diary yesterday, today and probably ALL week is yet another call to arms to PASS the bill: WHIP These Democrats Into Supporting The Health Bill!.
Yes, they are allies, not to be flamed, yet it was not too long ago when they were being flamed for expressing valid concerns.
Which leads me to ...
B.) We really need to start listening to each other
Yesterday when I awoke there were four dairies on the rec list, two of them were at the top of the rec list, and one of them in particular, by Colorado is the Shiznit, whom many here (including myself, and slinkerwink and nyceve,) respect: Why I can't support the HCR bill.
And last I checked, there were 2073 comments in response to her diary. No, I haven't waded through them. I don't need to, because, in response to her diary, (or maybe just in response to the heat of the day (it is hot here in Los Angeles)), we have three diaries responding to it, the most notable and direct was, of course: A disgraceful diary "Why I can't support the HCR bill".
Now, was that diary "Disgraceful?"
You decide for yourself, but here are the six(6) points which are the heart of what the diarist wrote:
The reasons I refuse to endorse this "reform" bill are as follows:
- The mandate. You cannot mandate people to, by law, purchase healthcare insurance if they don't have a public option to choose from. The alternative is simply too ghastly;
- The excise tax. This most certainly pits the middle class (as well as labor unions) against the poor, and I think that's absolutely disgusting. On its face, it is wholly undemocratic;
- This bill is a healthcare insurance industry giveaway, not dissimilar to the bank giveaway that the financial institutions received from the United States public in the fall of '08;
- Anti-abortion proponents' language, in both the House and the Senate bills, will still remain in the final product;
- Most of it doesn't go into affect until 2014. Wee; and (last but not least)
- The perfect is not the enemy of the good here. When the American people find out that they are mandated to buy insurance, and that they're paying for it (but the rich folk aren't contributing a single, solitary dime), the Democrats are going to lose, and lose big. Short-term gain does not matter to me if, long-term, we are fucking screwed. (No pun intended, actually.)
(highlights added by me)
The diarist's concluding recommendation: KILL THE BILL.
Now, do I agree with this recommendation? No. Because, yes, we have to start somewhere, I agree, and to kill this momentum would be foolish, I believe. But still, her points are entirely valid and entirely justified, I believe, (far more than I think most realize, which is the very point of my diary today,) and if not addressed, will have dire consequences, I believe. In other words, I do completely agree with her long-term prediction, namely: Democrats are going to lose, and lose big. My perspective, as mentioned above, is as an IT Professional, which is, by default, long-term, and as such, I do actually completely agree with this sentiment: Short-term gain does not matter to me if, long-term, we are fucking screwed. The purpose of this diary is to discuss, in PAINFUL detail, my long-term perspective. And, if you think HCR is important, then humor me, because this is a necessarily lengthy diary, which I have spent over a week compiling and writing.
Consider this deeply ...
These are non-trivial entirely valid points she is making and a rather catastrophically dire prediction, for all those of you who want to further the Democratic Party, and so, before you flame Colorado is the Shiznit, you may want to re-consider this prediction, and consider it long and hard, because the words, I told you so, don't begin to convey the enormity of what we are committing our nation's resources to embrace. In other words, this bill might not be a bitter pill, it might be a poison pill, and none of the three other diaries address this. Let me repeat it, because most are ignoring this prediction:
Democrats are going to lose, and lose big.
But, the truth is actually much MUCH worse than this, because if this Health Care Reform initiative fails, and fails huge, then not only will the Democratic Party loose big, but the progressive liberal movement will be crushed, and most importantly, along with this, the very ideology that there is a place for "Socialism" within the paradigm of our "Capitalism" will be crushed, for a generation, or longer.
Now, before I proceed to the next item, I want to review the other three diaries, to illustrate a point, namely, that the dialogue here on dailykos is misguided and ignoring the salient substantive issues and entirely valid concerns that are being raised, and furthermore, it is ignoring the real Action Items that these issues are demanding. And, NO, again, I am not referring to the "Kill the Bill" MEME, I am referring to the need to commit to the PO.
Please consider the questions I am posing for each:
- FIRST: Why was the diary "disgraceful?"
- SECOND: Can we afford a "crappy" piece of HCR Legislation today? (Note: "Crappy" is not my word, it is the diarist's.)
- THIRD: Will this Senate HCR Legislation do more harm than good?
(1) FIRST: Why was the diary "disgraceful?"
DIARY: A disgraceful diary "Why I can't support the HCR bill"
It is disgraceful that 33 million americans WHO HAVE NO DAMN HEALTHCARE are being trashed by this diarist WHO IS PERFECTLY WILLING THAT THEY CONTINUE TO BE WITHOUT HEALTH CARE!
MY RESPONSE:
Well, maybe this is true, on paper, at face value, but the mandating for people to pay for Health Insurance, to private insurance companies who are just squandering those payments on massively inefficient infrastructures, can hardly be said to constitute "providing them with health care." And, what if those companies fold, after taking people's money, but never deliver on providing payouts for benefits? This statement is making a huge assumption that these private insurance companies can be trusted to deliver on this promise, yet we all know that this industry is massively corrupt, and more importantly, this industry just suffered the worst financial collapse in recorded history, requiring massive funds to hold them up by their very bootstraps, and now you want to hand them a boatload of more funds, assuming they will, now, all of a sudden, be brilliant and honest? If you believe that one, I got a bridge in Brooklyn I'll sell you, cheap.
(2) SECOND: Can we afford a "crappy" piece of HCR Legislation today?
DIARY: Kucinich & Moore are wrong: Listen to Natoma Canfield
"Well, it just seems to me that everything needs a start."
I've blogged about this in the past but it's worth recapping: all major pieces of social legislation passed in this country in modern times started out crappy. For example, Social Security didn't originally cover most women or African Americans. Medicare also started out crappy but has been reformed over the years. The key was that we had something in place to build upon.
MY RESPONSE:
Maybe that is true about past legislations, in a prior era, but I would suggest that this current HCR is of an entirely different nature/magnitude, and the cost (financially and otherwise) for getting this wrong in such a profound manner, could be dire. The point being, it is not simply what is missing in this HCR Legislation, it is the fact that the very strategy for reform is wrong, this is our concern. The very nature of the approach is incorrect, this is our belief. This is what us "PO Zealots" are saying (i.e., it is not simply that my "pet item" is not on the list, as many have described the PO, but rather, the very list is problematic.)
Contrary to the popular belief of many politicians -- mandates and regulatory oversight are not the solution to all problems.
To a hammer, everything's a nail.
Yes, mandates and regulatory oversight solve certain problems, but not all. And so that no-one misunderstands me, let me be clear, I do believe that mandates and regulatory oversight are a crucial component of HCR, but it is not all, and more importantly, its failing is that it does not address the core problem, which is a pervasive systemic flaw in the very Health Insurance Industry's Service Model, which is most resoundingly NOT addressed by any imposed mandates or regulatory oversight agencies. In fact, efforts to do so are, I believe, entirely wasted and sadly, astronomically costly, as I discuss at length below. This is the mistake that the PO Zealots are most concern with, yet are either not expressing in clear enough terms, or these concerns are just not being heard. If they were, then the Democratic Leaders (Pelosi/ Reid/Obama), would be as adamant about the PO via Reconciliation, as they are about the HCR Legislation.
(3) THIRD: Will this Senate HCR Legislation do more harm than good?
DIARY: Look, the vote is this week
The mandate. You cannot mandate people to, by law, purchase healthcare insurance if they don't have a public option to choose from. The alternative is simply too ghastly;
Hell, I'd subsidize Halliburton if I knew it would cover 2/3 of my uninsured patients. What's more "ghastly", a private mandate in exchange for much better regulations, or leaving those 30 million people uninsured?
MY RESPONSE:
I saved this one for last, because this third diary's assertion does touch upon the issue, but the assertion is where the flaw is, I believe, which my diary intends to address more fully. But, to put it bluntly, the assertion, "I'd subsidize Halliburton if I knew it would cover 2/3 of my uninsured patients," assumes that this mandate will result in saving lives. This is the crux of the argument to pass this bill. But, let's review the assumptions inherent to this assertion:
- Yes, it will mandate 33 Million people to buy insurance, but it does not grant them insurance. It assumes that they will comply with that mandate. What if they do not? What if the disgruntled liberals join forces with the disgruntled teabaggers? Yes, I am sure we will have many who comply, but how do you respond to those who do not and what is the political fall-out of that response (this could get ugly), especially when quality health care services are not provided, which leads to ...
- This statement assumes that this hypothetical Halliburton won't be collapsed by the mandate. There is much work to be done to deliver on the long-term goals of this legislation. In other words, it assumes that the already over-burdened health care providers, and inefficient insurance companies, will be able to support the massive influx of newly insured (previously uninsured/never insured) folks. These are folks who will quite likely be demanding immediate service, quality service, comprehensive service, (possibly with an air of justified entitlement or bitterness for having to pay for an insurance premium that they never asked for), when none is to be had, or at least, not enough health care services are available. This is the classic problem with socialism. Socialism was great at taking a pre-industrial feudal society, the U.S.S.R., from producing zero(0) shoes, to producing 6 million shoes, virtually over-night, but forget about having half of them be left foot and the other half being right foot, or varying shoe sizes, weight, color, quality, type, etc. The quality of service degrades with mandated services. This is the argument that the Republicans live by. It is their mantra. And, it is an entirely valid argument. In fact, I would assert, this is what eventually led to the U.S.S.R.'s collapse.
Does the PO address the actual Health Care Provider Reform? Not directly, no, but the wasting of immense budgets and the committing of massive resources towards policing regulatory oversight mandates cannot be afforded in a time when there is so much that must be done in the other sectors of the health care industry. This is the problem.
TO MEND THE RIFT, WE MUST LISTEN TO EACH OTHER:
I do believe this rift in the Democratic Party can be mended if we all, on both sides of the debate, had a deeper understanding and appreciation of the issues and dynamics at play, and why it is a mistake to marginalize the demand for the PO. It is not a marginal issue; it is a MAJOR issue. I am going say this multiple times, but the PO is NOT my "pet thing," it is THE thing! Why? In short, because it addresses the Root Cause of the systemic problem and the current Senate HCR Legislation does not. What I recommend is for us to commit to the PO (short-term), and single-payer(long-term). This is what I want to see from the House, and most especially, for starters, from the Speaker of the House, and it is her failings, more than anything else, that drove me to write this diary. In short, we better damn well address these problems, and address them fast, if we want the Democratic Party to prevail and hold on to the reigns of power in this country for more than just a fleeting minute.
C.) YES! The current HCR Senate Bill must pass, BUT ...
Okay, I get it, this current HCR Senate Bill must be passed first, (with or without the PO, at first), for a whole host of reasons that are well explained by the Political Historians/Experts/wonks, and I am in complete support of this, (today, though I was not always) and apparently, so is our beloved Kos, today, (and I believe, with good reason,) so much so, that he was willing to issue a rather strong public threat to Kucinich, if he blocked it: Markos took the microphone on MSNBC Countdown and tore into Dennis Kucinich. He even went further to say that Kucinich should face a primary challenge, if he doesn't vote for the bill. Yes, I will genuinely praise its seminal passing, BUT without the simultaneous passing of the PUBLIC OPTION, the ultimate goal of true Heath Care Reform (improved services and cost reduction) will fail, I believe, and following this, as noted above, the ultimate political objectives of the Democratic Party will be hurt, potentially suffering a catastrophic fall from grace. Why? Well, in the simplest of terms, the means and ability to deliver on the long-term goals are what is missing from this debate. And as much as it is nice to hear that Gov. Howard Dean is going to fight for a public option until we get one, this is insufficient. "Until we get one," is just not good enough. The PO must be enacted immediately.
D.) Even Kucinich, a liberal hero, had to defend his position
Now, I am not going to defend his controversial threat to kill the Senate HCR Bill, and yes, I was glad to see Kos's primary threat, but still, the stand he is was taking is appreciated, (though, I believe, misguided) which demonstrates, however, just how deep this rift runs:
I mean, I have a responsibility to take a stand here on behalf of those who want a public option. There's about thirty-four members of the Senate, at least, who have signed on to saying they support a public option. If I were to just concede right now and say, "Well, you know, whatever you want. All this pressure's building. Just forget about it," actually weakens every last-minute bit of negotiations that would try to improve the bill. So I think that it's really critical to take this stand, because without it, there's no real control over premiums. Without it, we have nothing in the bill except the privatization of our healthcare system.
Of course, Kucinich capitulated, as we all knew he would, because "something is better than nothing":
"In the past week it's become clear that the vote on the final bill will be very close," Kucinich, who voted No last time because of the lack of the public option, said at a presser moments ago. He acknowleged that he'd be voting "not on the bill as I would like to see it, but as it is."
"However, after careful discussions with President Obama, Speaker Pelosi" and others, Kucinich said, "I've decided to cast a vote in favor of the legislation."
....
Kucinich said that ultimately he couldn't escape the argument that "something is better than nothing."
But my question is, will we forget his message, the very point of his hold-out to the last minute gesture? Shall his concerns go unheeded? I sincerely hope not.
E.) Some members of Congress get it and some don't
Congressman Alan Grayson gets it: H.R. 4789: The Public Option Act and has no problem taking a stand to make it happen.
DIARY TODAY: Grayson's Medicare Expansion Act, w/ 70+ Co-Sponsors
But, if Speaker Pelosi doesn't also step up to the plate, the failure will be on her head. The time for action is now, and in response to this imperative need, what does Pelosi do?
Pelosi Will Not Include the Public Option in Final Bill:
"We're talking about something that is not going to be part of the legislation," Pelosi said, noting "with sadness" that the public insurance option won't be part of legislation. "I'm quite sad that the public option is not in there," she said.
Please, Madam Speaker, you are NOT "quite sad," because if you were, then you would put the PO in there.
Pelosi is speaking as if she is not in charge. Pelosi is speaking as if she cannot take a stand. Pelosi is speaking as if she is not the Speaker of the House. Not to digress, but, this reminds me too poignantly of her ("impeachment is off the table") stance on impeachment and war crimes, wherein she is suggesting, by inference, that the prosecution of abuses committed by the Whitehouse is NOT the sole domain of the Congress. It matters not that the current President wants to "look forward." It is not for him to say, it is for the Congress to say. Please! Where's the Balance of Power? Now, if the current President wants to pardon someone, AFTER they have been convicted, now that is another thing entirely. But, as we all know, the prosecution for war crimes should have been commenced by Pelosi several years ago, before Obama even took office. My point is, Pelosi has a history of a lack of spine, when it matters most.
Which brings us to HCR, wherein spineless-avoid-the-heart-of-the-issue Pelosi does what, to reach out to the netroots blogging community? Does she open herself up to a discussion about the Public Option? NO! She posts a procedural question, as if she needs the blogging world to answer this question for her:
In the Speaker's Office
We're in the final push for the passage of the health insurance reform legislation, and Speaker Pelosi has convened a roundtable of bloggers to discuss the endgame.
Option 1: Hold separate votes on passage of the Senate bill (actually, a vote on agreeing to the Senate amendment to H.R. 3590) and then a vote on the reconciliation package containing the fixes.
Option 2: Place self-executing language in the rule for the reconciliation bill that deems the Senate amendments agreed to upon passage of the rule.
Option 3: Place self-executing language in the rule for the reconciliation bill that deems the Senate amendments agreed to upon passage of the actual reconciliation bill in the House.
"Impeachment is off-the-table" Pelosi, has become ...
"The Public Option is off-the-table" Pelosi!
Please, Madam Speaker, pardon my French, but, who the fuck do you think you're fooling?
Now would be a good time to use the word "disgraceful!" Can we primary this spineless wimp, or at the very least, replace her as Speaker of the House, preferably with a woman with spine, so that the women of this world won't be harmed by her piss-poor demonstration of what we can expect from a female leader in our government.
If I may make note of the message these spineless members of congress need to hear:
Chet Edwards: "It's clear to me they could care less about my political future."
Rep. Chet Edwards, a Texas Democrat who remains a firm "no," said he's getting calls spurred by Organizing for America, the president's unofficial outreach arm. He said he's fine with constituents expressing their opinions - and even with the right of OFA to engage - but noted of the Obama organization, "It's clear to me they could care less about my political future."
As TomP said:
You're damn right, Mr. Edwards. We don't care.
Yes, if they don't care about us, the people, why should we care about them? Pelosi should think well and hard on this same question.
Which leads me to ...
F.) The Democratic leaders in Congress need to take a stand
Let's be clear, if the PUBLIC OPTION is not in the House "Reconciliation" Bill, it is because Pelosi, herself, did not take a stand to put it there. This ain't about the Senate, this is about Pelosi's lack of commitment -- nothing more, nothing less. Everything else, with all due respect, is fucking bullshit!
We need the members of Congress to show a little spine and rise to the occasion and do what is right -- to do what is necessary -- to do what is needed! As Obama recently said in his speech at Claire McCaskill's fundraiser in St. Louis, "put aside your worries about the next election" ... yeah, a little boldness would be nice and refreshing from the Congress.
If I may wax-poetic for a moment, and quote Goethe ...
Whatever you can do or dream you can, begin it.
Boldness has genius, power and magic in it.
And, a little boldness would probably win them elections anyway, and bolster the Democratic Party's image as a party with backbone, so I honestly don't know why they are so afraid. Yeah, as us former Republicans like to say, no surprise from the spineless liberal. I guess when you've been raised in a culture of fear, it is hard to break the habit of cow-towing. You know, for a moment when I heard how she was calling Stupak's bluff, I thought that maybe she had "grown a pair," but obviously I was mistaken. All talk, no action. My message to Pelosi, as a New Yorker, "Put up, or shut up!" This is one of those times where either you are for us or against us. The line has been drawn in the sand, and the PO is the litmus test, because it is THAT important. Yeah, it is, and yes it is that urgent.
And, no surprise, I just yesterday received an email from Congressman Alan Grayson,
ENTITLED: A Congress with Guts
And just this morning, I received an email from Obama with the following quote:
As I was finishing my remarks Monday, a woman in the crowd called out,
"We need courage!" She's right.
Yes, a little guts and courage from our member in Congress would be nice!
G.) The Senate has taken a stand
Speaking of boldness, a few days ago I received an email from boldprogressives.org,
ENTITLED: BREAKING: 51 votes in Senate for public option
VIDEO: WhipCongress.com: 51 votes for public option if House goes first
H.) In Summary
Yes, I am in support of the current Senate HCR Legislation, and yes, it is a good and admirable beginning, a "foot in the door," as they say, but don't tell me that the PO is not a realistic expectation from the Congress today (via Reconciliation), and furthermore, given the fact that from my professional perspective, there could be serious harm from the current HCR legislation, (political and industry-wide -- in the Public and Private Sectors) if enacted without the PO, then to not take a stand on this, is a profound mistake. As an IT Professional with several decades experience working with Fortune 100 companies across numerous industries (including Health Care and Insurance) on multi-million dollars projects, it is my professional opinion, from my analysis, that the PO is imperative, as our over-arching strategic direction, and eventually, single-payer. I am not saying that the current HCR Bill is "crap" or "useless" without the PO, (nor am I suggesting that the current HCR Legislation should not be passed without the PO -- you do what you can, and go from there) but what I am saying is that there is a serious problem with the current Senate HCR Legislation, if not immediately coupled with the PO. And, I want people to understand and appreciate the dangers and problems that I see. I am taking a stand, at the heart of the rift within the Democratic Party, and this diary is an effort to explain why.
The devil's in the details.
II. MY PERSPECTIVE
A.) The nature of the problem
In my profession we analyze Enterprise-Wide Systems Integration projects of this magnitude from several perspectives, e.g.:
(a) Strategic Industry Analysis
(b) Corporate Change Management
(c) Business Process Reengineering
(d) Enterprise Architecture / Application Architecture
To give you a few visuals of what Enterprise Integration involves:
These concepts are important to understand because the nature of this discussion is very complex, and if we want to truly appreciate what is at stake here, and what it actually requires to achieve true reform, then we must consider far more than the conventional political dialogue (which is all that seems to be dominating the current discourse), and look at this from the perspective of those who actually deliver on the promises and mandates. Relatively speaking, it is easy for a legislator to write a mandate on a piece of paper, and further, it is easy for a bunch of analysts to calculate a host of "theoretical" savings, but delivering on those mandates, and achieving those savings, involves quite another thing entirely.
B.) The HCR Senate Bill will achieve ...
New CBO numbers: HCR cuts deficit by $118 billion
The non-partisan CBO said in its updated assessment that the Senate bill would cost 875 billion dollars over 10 years and reduce projected budget deficits by 118 billion dollars.
Really? Are you sure?
Not to be a naysayer or disparage the professional job that the non-partisan CBO did, which I am sure was as thorough and well-researched as possible, but with all due respect to the analysts, but probably over 90% of the multi-million dollar Enterprise Operational Change projects FAIL to achieve their desired cost savings, and over 60% of them fail entirely, and that is almost always for just one single corporation. Now, I am not trying to support any Republican talking points that oppose HCR, because I am 100% in support of it, because, no matter what, we must do something -- we must start somewhere -- and we must begin now. But, let us be clear, the HCR will cost trillions and affect far more than just one single Enterprise's Operating Model. How can you be so sure that those savings will actually be realized? You cannot!
With HCR and the PO, the scope of change is far more complex and the issues that must be considered, far greater, than has ever before even been contemplated. This is a broad national initiative with far reaching implications, inciting heated political debates on both sides of the partisan divide, affecting countless corporations across numerous industries, costing untold trillions, in both the public and the private sector. The success of HCR requires far more critical thinking then any project here-to-fore, and as such, it requires a far more involved conversation and a far deeper understanding, than the simple immediate political fallout, this November 2010. This will affect November 2012, November 2014, November 2016, and far more years to come.
C.) I respect the need for Democratic Party unity
Yes, I well appreciate the need for unity, and further, I do appreciate that we do not want to "shoot ourselves in the foot" by tearing our own party apart, and, as the proverb goes ...
A man's greatest strength can be their greatest weakness, and
a man's greatest weakness can be their greatest strength
... and this is most especially true with the Democratic Party, and in particular, this is certainly true with HCR legislation. The strength of the Progressive Caucus is in the constructive and necessarily critical diverse opinions. And, although this diversity can be viewed as disparaging, that is not, I believe, the intent, nor does it need to be a detriment, in fact, it should be viewed as an asset that will ensure the ultimate success of HCR, and whether or not we achieve the real ultimate goals, which is: to increase efficiency and quality, whilst reducing overall costs.
Let us remember, it is one thing to mandate 30 Million people to sign up for, and pay for, an Insurance Plan, (even if it is made relatively "affordable" by regulatory legislation), and it is quite another thing to achieve an overall reform of the health care industry, at large.
D.) Where are the real battles? What is the real War?
Let us have a discussion about discussion, and why we need to embrace the details of this dialogue, not shy away from it. Let us remember, Obama's campaign strategy involved creating an "awakened electorate." This was the charge that inspired and mobilized the grass roots movement -- mobilized the netroots nation -- mobilized the young generation. And, at the heart of this was Obama's effort to raise the dialogue above the superficially ignorant "MEMEs" that drive the Republican base. This was a concerted effort, by Obama, to actually go beyond the 15 second sound bites -- to dig under the surface to the real issues.
God is in the details.
This is where the real distinction between the Democratic Party and the Republican Party becomes clear and obvious. This is where the real work is done. This is where the substantive debates occur. This is where Obama shines, and this is how he beat Clinton, first, and then McCain. And, if I may suggest, this is the true war that the Progressive Caucus must fight AND WIN, if we are to achieve true progress.
And, similarly, this is what IT Professionals must grapple with when we engage in multimillion dollar multi-year projects that require massive change affecting all segments of a corporation's infrastructure. The challenge is not simply the building of the physical systems, but also, it is equally a challenge to educate the management and staff -- to educate the stake holders. In fact, the dialogue itself is usually the most difficult ... and error prone. The dialogue is usually where projects fail. First and foremost, one must establish a mutual shared vision, which requires an in-depth knowledge of the critical issues, along with, a correct identification of the root cause of the problem.
REAL LIFE EXAMPLE:
One can spend thousands of dollars replacing a corporate network when the real problem could have been corrected by simply fixing a database system which was poorly designed and caused massive unnecessary bandwidth utilization.
This example speaks to the need to address the Root Cause of a problem, if a project's goals are to be realized in an efficient manner.
This is a dialogue that mandates that one dig into the details, to discuss sensitive issues (C-Y-A), political agendas, fiefdoms, cultural habits, and resource limitations, as well as, down right ignorance. In fact, the job of an IT Professional is often far more about education, than anything else.
E.) Fighting the Republican MEME's
The Republicans' strategy is to employ MEME's which are specifically intended to circumvent and derail the education process. They do NOT want any detailed discussion. They do not want to raise the dialogue. They do NOT want an "awakened electorate" because they know that they cannot control "awakened electorate" with MEME's. Their strength exists only when the populace is blindly responding solely driven by base emotional reactions, and thus, the only way to fight the real battle, is through detailed dialogue -- to raise the dialogue -- to educate and awaken people to the real issues. This is how Obama won the election. And, similarly, this is where our true and lasting "*PROGRESS*" as a Progressive Causus is forged. And, so, with HCR, this requires an involved dialogue -- this mandates a detailed discourse -- in the spirit of the ancient disputations wherein opposing discerning viewpoints contributed to, and furthered, the ultimate goal, which is -- true understanding! This commentary is an effort to provide some insight into why the PUBLIC OPTION is so critical, and should not be discounted as an "aside" or a "pet item," but rather, as the true war ... and furthermore, why the discussions concerning it so crucial.
Know Thy Enemy ...
The Republican National Committee plans to raise money this election cycle through an aggressive campaign capitalizing on "fear" of President Barack Obama and a promise to "save the country from trending toward socialism."
Remember these ...
Mastery is in the details.
III. SHARED VISION
A.) The PO is both critical and urgent
(1) THE PUBLIC OPTION IS A STRATEGIC DIRECTION:
The PO is not just a simple minor "addition", it is a completely different strategy/approach for achieving HCR than the current HCR legislation, which employs regulatory mandates that require costly policing agencies to enforce/impose upon those mandates upon the private sector health insurance providers. As opposed to, the diametrically opposite strategy of introducing a National Public Sector Health Insurance Provider, the "PO", and thus simply letting the market economy forces of competition (at zero cost), effectuate reform.
(2) ADDRESSING THE ROOT CAUSE OF THE PROBLEM:
There is a very real danger that more harm can be done than good, if we do not address the real problem, which is not solved by a mandate for 30 million to get insurance, nor by regulatory stipulations imposed upon insurance companies, stipulations that are fraught with loopholes. Now, the mandate was explicitly not Obama's campaign pledge, it was Clinton's, but still, I do understand the need for it, and again, we must start somewhere, and this apparent "boon" for the insurance companies might have been the only way to get a bill passed ... with the bluedog dems working in conjunction with the obstructionist Republicans in the Senate using filibusters to block everything they could. Yeah, I get it. And so yes, I agree, to kill this bill now would be suicide for the Democratic Party, and worse, it would be suicide for HCR in general. But, let me be clear, I push for the PO because, I believe, without it, the heart or root of the problem is not addressed. This is why I am zealously pushing for it.
(3) THE DEMAND FOR THE PO AND THE MANDATE LIE:
The PO via RECONCILIATION is an idea whose time has come, and there is no way that the democratic party can stop or avoid the momentum/demand for this without causing irreparable damage to the party. You will not be able to browbeat the progressive movement into demanding anything less, nor will you be able to convince them it is not imperative. Obama conducted a Presidential campaign wherein he EXPLICITLY said (unlike Clinton) that a mandate was NOT part of his HCR legislation, and now it is, which makes Obama a liar. Now, please, I am not calling Obama disparaging names, I am merely stating the facts. And, there is simply no way Obama is gonna hide this lie, and even if the progressives don't call him on it, (and you know very well that they will call him on it, because, unlike conservatives, progressives hate liars, on either side of the isle ... heck, the progressives already are calling him on this), but even worse, the Republicans will crucify him for this, you can bet you bottom dollar on that. And so, he had better have a good response that at least addresses the valid concerns of the progressives. And, no matter how many times Obama makes speeches touting the 30+ million more people covered, this will not change the lie!
(4) THE MANDATE IS THE PROBLEM, THE RUB:
Yes, I understand why President Obama did it, and I am not saying it was wrong, or that I even disagree with it, in fact, I do think it might have been necessary, but a lie is still a lie, and in this instance, this lie hands billions to the corrupt and failing Private Insurance companies --- and therein lies the rub!
There is simply no way you will be able to sell this to an internet community who ALREADY knows the truth about those PRIVATE insurance companies. And, knowing what we already know about them, do you honestly believe that we are gonna, or that we even should, all of a sudden, trust them to deliver on those mandates, in good faith, unilaterally, without massively wastefully costly, all-too-often ineffective, policing, when it is in their best interests, financially, to circumvent such mandates, whenever and wherever possible -- and they are experts with a long history of doing so!
Please! There's this really cool bridge in Brooklyn, you can have it for cheap!
(5) THE PO IS NOT A "PET ITEM" ON MY LIST:
Let's get this one straight, once and for all, the PO is not an afterthought, nor is it a minor addition, nor is it merely my own "pet item on a list" ... rather, I believe, as many progressives obviously also believe, that it is core and paramount and necessary, to achieve true HCR. In fact, without it, I believe this effort will be a massive debacle, costing billions, causing more harm than good. Let us recall, the driving goal must include "bending the cost curve", and if it does not, and further, if it increases the cost curve, DRAMATICALLY, the effects of this will be dire, and the political fall-out will crush this burgeoning new progressive movement while we are still in our infancy.
Need I remind you of the ominous prediction:
Democrats are going to lose, and lose big.
Yes, I believe there is a very real danger of this. And, the concerns expressed by many members of this site echo this very same sentiment. And, one must give this credence, if for no other reason that simply by virtue of the very existence of this pervasive concern, expressed by so many prominent respected long-standing members. This, alone, makes it a realistic possibility, a possibility that must be addressed, if for no other reason, than to mend the schism and rift in the Democratic Party, a rift the runs through the heart of dkos itself.
(6) STARTING HCR WITH THE CORRECT STRATEGIC DIRECTION:
The Senate HCR Bill is flawed, no doubt, and yes, as Obama recounted about the history of other pieces of legislation over the years, they are never perfect to begin with, and so, yes, we must begin somewhere, and maybe Obama did not have the votes for the PO, prior to now, and so, he/congress are doing what he/they can, with this first piece of HCR legislation, and yes, 30 million covered is profound, but as a mandate it is not exactly a gift to the people, especially if they cannot afford it, but rather, as stated multiple times, it is a gift to the Private Insurance companies. It is, in effect, a new tax on the poor to benefit the rich, and you can be sure that it will be framed as such. As many have noted, it is a boon to the insurance companies! This must not be ignored nor discounted. Yes, we must start somewhere, and once a bill is enacted, a momentum is begun, and corrections can be made, as long as we know what that direction is. It is not that I believe the current bill is "crap," just that it does not have the necessary teeth, from a "Strategic Change Management" perspective. It sets the wrong strategic direction. The focus is misplaced. It will spawn yet more governmental bureaucratic waste --- waste that we cannot afford --- and all the while, handing insurance companies billions -- billions that came from the imposed mandate.
I am reminded of a saying my aikido teacher(sensei) used to say to me ...
When you are shooting at the moon, if your aim is off, even a fraction of an inch, it will be 10,000 miles.
B.) What is the danger?
Massive funds are going to be expended on the necessary policing measures to interpret and enforce these new regulations, regulations that are most certainly flawed, but it is not the flaws that concerns me, it is the fact that the massive funds will be entirely misplaced and thus wasted, because "policing regulations" is not where we will achieve the transformation of the health care industry's very paradigm, which is what we need for true reform. How much time and resources will be wasted on a fools errand, before we embark on the right strategy?
Massive systems, infrastructures, governmental and industry-wide, will need to be retooled to support such mandates and ensure such regulatory measures are complied with -- legal institutions must adjust -- actuarial statistical analysis -- business process redesign -- IT systems -- etc. This is what I do for a living and whist I appreciate the massive influx of work, I have seen too many projects fail and too much money and time wasted, when a subtle yet profound course correction today, will save years and billions. This is why I am, what some disparagingly call, a "PO zealot." This is why I believe it is imperative -- sooner, rather than later.
C.) Future Elections -- 2010, 2012, 2014, 2016, Etc.
My goal is not just an electoral "win" today, but to set a precedent, to accomplish True HCR. This will not only win us this next election this coming November, but will ensure a wave that will carry us for a generation, such that this dominant paradigm of corrupt politicians who serve corporate interests while fucking over people, ends. There will always be a measure of corruption, of course, in both parties, as we recently saw, even in our dem party, but the current condition of our nation, having been brought to the brink of disaster, by that very corruption, along with, ineptitude and wanton short-sighted greed, this is unprecedented and will be our ruin, (China, Russia, Europe, etc. are all on the rise!), if not corrected, and this requires impeccable leadership driven by a sound strategy.
I have no inherent problem serving the needs of large corporations, as long as we ALSO serve the needs of individual people, at the same time -- a "win win" scenario. Heck, I have made a healthy living serving large corporations for most of my life, and no matter what the anti-capitalist will tell you, I don't find them to be inherently evil, just a little inept and misguided, or short-sighted, at times.
Which leads me to ...
D.) A Healthy Efficient Government (Public Service) Institution
My background is pointedly, as I have mentioned, correcting systemic problems in large Fortune 100 Enterprises, and so this is how I look at politics today and this is how I would like you all to consider looking at this problem of HCR -- not just as a political partisan battle, but rather, as a "systemic problem solving" war. I saw Obama as a man/leader who listened, at a time when we needed it most. One of my mentors, during my college years, (25 years ago) had been a student from the Chicago school of economics, who were, in case you didn't know, the authors of the now infamous much disparaged supply-side "Reaganomics" which has dominated our fiscal policies for a generation, and the apparent market economy benefits from "privatization," miscalled "deregulation" have been the most misunderstood and misplaced fiscal polices, ever, which led to the repeal of the Glass-Steagall Act of 1933, which set the stage for our current crisis, though hardly the only contributing factor/force. Regulatory measures are imperative, yes, but they are not the "silver bullet" to address all problems. They can become extremely costly, ineffective and constrictive of the free market, if applied to the wrong situations to address the wrong problems.
As my aikido teacher also would say ...
to a hammer, everything's a nail
Regulatory reform is not the answer to all problems, nor are mandates for a populace to sign up to pay for insurance from a private sector insurance provider who is corrupt, or whose business model is flawed and thus will never be able to properly effectively efficiently service that need.
There are no silver bullets without a golden path
The PO is the path, the strategy, the direction -- this is why I am adamant about it.
My goal is for us to forge a strategy that will result in an efficient governmental institution that will be capable of facilitating HCR in each of the relevant respective sectors across the entire spectrum of health care provider services ... as opposed to the creation of yet another monolithic governmental bureaucratic nightmare that just makes the corrupt and failing private sector insurance companies even more money to squander, like they have done for far too long.
E.) The Real War: A Battle of MEME's
The Republicans want to frame this as a battle of Capitalism vs. Socialism!.
My response is that we need elements of both -- a HYBRID industry service model.
RYO-DO ~ "The Way of Both"
The misplaced fears of "socialism," which IS the main MEME of the Republicans and their tea party fools, is derived from both valid and invalid concerns. There are real benefits and real problems with both service models, and unless we proceed with the right formula/strategy, we will suffer the mistakes of both, and the benefits of neither ... and all the while, the Republicans will be spreading more lies and promoting even more fear and distrust of the Democrats, and amidst this, people will be dying from a collapsing health care system, the collapse of which might be hastened by a flawed strategy.
Socialistic "Public Sector" Service Models are not bad or evil or necessarily inefficient, in certain situations, to address certain needs, most notably, with "shared infrastructure services" to avoid duplication and unnecessary wasteful competition and reap the benefits of the economies of scale that are derived from a well thought-out properly run national institution, which is, of course, easier said than done.
Over the course of the last century there has been, often times, an irrational fear of anything labeled "socialism" whilst on the other side, with Reagan's fiscal policies, there has been a misplaced belief that "privatization" is the "silver-bullet" for all problems, and neither is accurate. These two mistakes are at the heart of the Republican ideological beliefs today and you can clearly see this if you question any Republican on their fiscal policies. These mistaken beliefs/MEMEs must be corrected, if we are to ensure that the current crop of corrupt politicians do not take control of our government again. And, the proper HCR Legislation, delivering true reform, will teach our society an invaluable lesson about the need for a balanced hybrid strategy for public services without having to fear the ghosts of communism. And, with the rise of China, it would also be a invaluable lesson to demonstrate --- through a leadership of example --- a superior economical model that reaps the benefits of both approaches to providing for the needs of people and thus fostering prosperity.
The road to hell is paved with good intentions!
IV. CONCLUSION
A.) The law of unintended consequences
To hear is to forget,
To remember is to listen,
To do is to understand-
~ Ninpo Proverb ~